title: Low local recurrence rate without postmastectomy radiation in node-negative breast cancer patients with tumors 5 cm and larger.
abstract: OBJECTIVE
  To assess the need for adjuvant radiotherapy following mastectomy for patients with node-negative breast tumors 5 cm or larger.
  
  
  METHODS
  Between 1981 and 2002, a total of 70 patients with node-negative breast cancer and tumors 5 cm or larger were treated with mastectomy and adjuvant systemic therapies but without radiotherapy at three institutions. We retrospectively assessed rates and risk factors for locoregional failure (LRF), overall survival (OS), and disease-free survival (DFS) in these patients.
  
  
  RESULTS
  With a median follow-up of 85 months, the 5-year actuarial LRF rate was 7.6% (95% confidence interval, 3%-16%). LRF was primarily in the chest wall (4/5 local failures), and lymphatic-vascular invasion (LVI) was statistically significantly associated with LRF risk by the log-rank test (p=0.017) and in Cox proportional hazards analysis (p=0.038). The 5-year OS and DFS rates were 83% and 86% respectively. LVI was also significantly associated with OS and DFS in both univariate and multivariate analysis.
  
  
  CONCLUSIONS
  This series demonstrates a low LRF rate of 7.6% among breast cancer patients with node-negative tumors 5 cm and larger after mastectomy and adjuvant systemic therapy. Our data indicate that further adjuvant radiation therapy to increase local control may not be indicated by tumor size alone in the absence of positive lymph nodes. LVI was significantly associated with LRF in our series, indicating that patients with this risk factor require careful consideration with regard to further local therapy.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Floyd
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Haffty
authors.forename: Saveli
authors.initials: S
authors.lastname: Goldberg
authors.forename: Andrzej
authors.initials: A
authors.lastname: Niemierko
authors.forename: Rita Abi
authors.initials: RA
authors.lastname: Raad
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Oswald
authors.forename: Timothy
authors.initials: T
authors.lastname: Sullivan
authors.forename: Eric A
authors.initials: EA
authors.lastname: Strom
authors.forename: Simon N
authors.initials: SN
authors.lastname: Powell
authors.forename: Angela
authors.initials: A
authors.lastname: Katz
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies