title: Patterns and risk factors for locoregional failures after mastectomy for breast cancer: an International Breast Cancer Study Group report.
abstract: BACKGROUND
  Rates and risk factors of local, axillary and supraclavicular recurrences can guide patient selection and target for postmastectomy radiotherapy (PMRT).
  
  
  METHODS
  Local, axillary and supraclavicular recurrences were evaluated in 8106 patients enrolled in 13 randomized trials. Patients received chemotherapy and/or endocrine therapy and mastectomy without radiotherapy. Median follow-up was 15.2 years.
  
  
  RESULTS
  Ten-year cumulative incidence for chest wall recurrence of >15% was seen in patients aged <40 years (16.1%), with ≥4 positive nodes (16.5%) or 0-7 uninvolved nodes (15.1%); for supraclavicular failures >10%: ≥4 positive nodes (10.2%); for axillary failures of >5%: aged <40 years (5.1%), unknown primary tumor size (5.2%), 0-7 uninvolved nodes (5.2%). In patients with 1-3 positive nodes, 10-year cumulative incidence for chest wall recurrence of >15% were age <40, peritumoral vessel invasion or 0-7 uninvolved nodes. Age, number of positive nodes and number of uninvolved nodes were significant parameters for each locoregional relapse site.
  
  
  CONCLUSIONS
  PMRT to the chest wall and supraclavicular fossa is supported in patients with ≥4 positive nodes. With 1-3 positive nodes, chest wall PMRT may be considered in patients aged <40 years, with 0-7 uninvolved nodes or with vascular invasion. The findings do not support PMRT to the dissected axilla.
authors: Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: per.karlsson@oncology.gu.se.
authors: P
authors: P
authors: Karlsson
authors: Department of Mathematics and Statistics College of Engineering and Mathematical Sciences, University of Vermont, Burlington; IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, USA.
authors: B F
authors: BF
authors: Cole
authors: Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia.
authors: B H
authors: BH
authors: Chua
authors: IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, USA; Frontier Science and Technology Research Foundation, Boston, USA.
authors: K N
authors: KN
authors: Price
authors: The Institute of Oncology, Ljubljana, Slovenia.
authors: J
authors: J
authors: Lindtner
authors: Department of Surgery, Royal Melbourne Hospital, Victoria, Australia.
authors: J P
authors: JP
authors: Collins
authors: Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: A
authors: A
authors: Kovács
authors: The Breast Center, Kantonsspital, St Gallen, Switzerland and Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland.
authors: B
authors: B
authors: Thürlimann
authors: Department of Medical Oncology, Centro di Riferimento Oncologico, Aviano, Italy.
authors: D
authors: D
authors: Crivellari
authors: Gyneco-Oncology Unit, University Hospital, Geneva, Switzerland.
authors: M
authors: M
authors: Castiglione-Gertsch
authors: Australian New Zealand Breast Cancer Trials Group, University of Newcastle, Calvary Mater Newcastle, Newcastle, Australia.
authors: J F
authors: JF
authors: Forbes
authors: IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, USA; Frontier Science and Technology Research Foundation, Boston, USA; Harvard School of Public Health and Harvard Medical School, Boston, USA.
authors: R D
authors: RD
authors: Gelber
authors: European Institute of Oncology, Milan, Italy; Swiss Center for Breast Health, Sant'Anna Clinics, Lugano-Sorengo.
authors: A
authors: A
authors: Goldhirsch
authors: Institut fuer Radiotherapie, Klinik Hirslanden, Zürich, Switzerland.
authors: G
authors: G
authors: Gruber
mesh_terms: D000328:Adult; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018714:Radiotherapy, Adjuvant; D011960:Receptors, Estrogen / Q000378:metabolism; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D011960:Receptors, Estrogen