title: Patterns and risk factors of locoregional recurrence in T1-T2 node negative breast cancer patients treated with mastectomy: implications for postmastectomy radiotherapy.
abstract: OBJECTIVE
  Postmastectomy radiation therapy (PMRT) can reduce locoregional recurrences (LRR) in high-risk patients, but its role in the treatment of lymph node negative (LN-) breast cancer remains unclear. The aim of this study was to identify a subgroup of T1-T2 breast cancer patients with LN- who might benefit from PMRT.
  
  
  METHODS
  We retrospectively reviewed 1,136 node-negative T1-T2 breast cancer cases treated with mastectomy without PMRT at the Massachusetts General Hospital between 1980 and 2004. We estimated cumulative incidence rates for LRR overall and in specific subgroups, and used Cox proportional hazards models to identify potential risk factors.
  
  
  RESULTS
  Median follow-up was 9 years. The 10-year cumulative incidence of LRR was 5.2% (95% CI: 3.9-6.7%). Chest wall was the most common (73%) site of LRR. Tumor size, margin, patient age, systemic therapy, and lymphovascular invasion (LVI) were significantly associated with LRR on multivariate analysis. These five variables were subsequently used as risk factors for stratified analysis. The 10-year cumulative incidence of LRR for patients with no risk factors was 2.0% (95% CI: 0.5-5.2%), whereas the incidence for patients with three or more risk factors was 19.7% (95% CI: 12.2-28.6%).
  
  
  CONCLUSIONS
  It has been suggested that patients with T1-T2N0 breast cancer who undergo mastectomy represent a favorable group for which PMRT renders little benefit. However, this study suggests that select patients with multiple risk factors including LVI, tumor size ≥2 cm, close or positive margin, age ≤50, and no systemic therapy are at higher risk of LRR and may benefit from PMRT.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Rita
authors.initials: R
authors.lastname: Abi-Raad
authors.forename: Rimoun
authors.initials: R
authors.lastname: Boutrus
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.forename: Andrzej
authors.initials: A
authors.lastname: Niemierko
authors.forename: Shannon
authors.initials: S
authors.lastname: Macdonald
authors.forename: Barbara
authors.initials: B
authors.lastname: Smith
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D047368:Tumor Burden