title: Locoregional failure in early-stage breast cancer patients treated with radical mastectomy and adjuvant systemic therapy: which patients benefit from postmastectomy irradiation?
abstract: OBJECTIVE
  To assess the locoregional failure in patients with Stage I-II breast cancer treated with radical mastectomy and to evaluate whether a subset of these patients might be at sufficiently high risk of locoregional recurrence (LRR) to benefit from postmastectomy irradiation (PMRT).
  
  
  METHODS
  Stage I-II breast cancer patients (n = 150) treated with radical mastectomy without adjuvant irradiation between 1999 and 2005 were analyzed. The pattern of LRR was reported. Kaplan-Meier analysis was used to calculate rates of LRR, and Cox proportional hazards methods were used to evaluate potential risk factors.
  
  
  RESULTS
  Median follow-up was 75 months. Mean patient age was 56 years. One-hundred forty-three (95%) patients received adjuvant systemic therapy: 85 (57%) hormonal therapy alone, 14 (9%) chemotherapy alone, and 44 (29%) both chemotherapy and hormonal therapy. Statistically significant factors associated with increased risk of LRR were premenopausal status (p = 0.004), estrogen receptor negative cancer (p = 0.02), pathologic grade 3 (p = 0.02), and lymphovascular invasion (p = 0.001). T and N stage were not associated with increased risk of regional recurrence. The 5-year LRR rate for patients with zero or one, two, three, and four risk factors was 1%, 10.3%, 24.2%, and 75%, respectively.
  
  
  CONCLUSIONS
  A subset of patients with early-stage breast cancer is at high risk of LRR, and therefore PMRT might be beneficial.
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano, Italy. marcotrovo33@hotmail.com
authors.forename: Marco
authors.initials: M
authors.lastname: Trovo
authors.forename: Elena
authors.initials: E
authors.lastname: Durofil
authors.forename: Jerry
authors.initials: J
authors.lastname: Polesel
authors.forename: Mario
authors.initials: M
authors.lastname: Roncadin
authors.forename: Tiziana
authors.initials: T
authors.lastname: Perin
authors.forename: Mario
authors.initials: M
authors.lastname: Mileto
authors.forename: Erica
authors.initials: E
authors.lastname: Piccoli
authors.forename: Daniela
authors.initials: D
authors.lastname: Quitadamo
authors.forename: Samuele
authors.initials: S
authors.lastname: Massarut
authors.forename: Antonino
authors.initials: A
authors.lastname: Carbone
authors.forename: Mauro G
authors.initials: MG
authors.lastname: Trovo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015409:Mastectomy, Radical; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011182:Postoperative Care; D016016:Proportional Hazards Models; D011960:Receptors, Estrogen / Q000032:analysis; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D000970:Antineoplastic Agents; D011960:Receptors, Estrogen