title: Postmastectomy radiation therapy for lymph node-negative, locally advanced breast cancer after modified radical mastectomy: analysis of the NCI Surveillance, Epidemiology, and End Results database.
abstract: BACKGROUND
  The role of postmastectomy radiotherapy (PMRT) for lymph node-negative locally advanced breast carcinoma (T3N0M0) after modified radical mastectomy (MRM) with regard to improvement in survival remains an area of controversy.
  
  
  METHODS
  The 1973-2004 National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) database was examined for patients with T3N0M0 ductal, lobular, or mixed ductal and lobular carcinoma of the breast who underwent MRM, treated from 1988-2003. Patients who were men, who had positive lymph nodes, who survived < or =6 months, for whom breast cancer was not the first malignancy, who had nonbeam radiation, intraoperative or preoperative radiation were excluded. The average treatment effect of PMRT on mortality was estimated with a propensity score case-matched analysis.
  
  
  RESULTS
  In all, 1777 patients were identified; 568 (32%) patients received PMRT. Median tumor size was 6.3 cm. The median number of lymph nodes examined was 14 (range, 1-49). Propensity score matched case-control analysis showed no improvement in overall survival with the delivery of PMRT in this group. Older patients, patients with ER- disease (compared with ER+), and patients with high-grade tumors (compared with well differentiated) had increased mortality.
  
  
  CONCLUSIONS
  The use of PMRT for T3N0M0 breast carcinoma after MRM is not associated with an increase in overall survival. It was not possible to analyze local control in this study given the limitations of the SEER database. The impact of potential improvement in local control as it relates to overall survival should be the subject of further investigation.
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06520, USA. james.b.yu@yale.edu
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Wilson
authors.forename: Tina
authors.initials: T
authors.lastname: Dasgupta
authors.forename: William A
authors.initials: WA
authors.lastname: Castrucci
authors.forename: Joanne B
authors.initials: JB
authors.lastname: Weidhaas
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D018426:SEER Program; D016019:Survival Analysis