There is no definite consensus on the role of post-operative radiotherapy (RT) in breast cancer patients with 1-3 axillary lymph node positivity. EBCTCG meta-analysis and Danish trials (DBCG 82 b and c) showed improvement in loco regional control and overall survival (OS) with post operative radiotherapy in 1-3 node positive patients, but level I evidence is awaited [SUPREMO trial]. With this background we conducted this retrospective analysis to evaluate clinical outcomes of patients with 1 to 3 axillary node positive breast cancer.
From 1 January 2010 to 31 December 2014, a total of 474 patients with pT1-T2 pN1 breast cancer were identified from Hospital Registry. Clinical outcomes in terms of Disease Free Survival (DFS), Local Recurrence Rate (LRR), OS and patterns of failure were assessed.
Of the 474 patients, all of them except 3 were females, with a mean age of 52 years. 89% of the patients had >/=10 axillary lymph nodes dissected and around half of the patients studied had single node positivity. Adjuvant RT was given to 364 patients (76.8%) and 75.5% of them received conventional fractionation schedule. The median follow up was 77.4 months. At the time of analysis, 403 patients were alive without any evidence of disease. Forty-one patients died due to disease sequelae and 8 patients were alive with disease. The 5 year OS and DFS were 93% and 89.4% respectively. Eighteen patients (3.7%) had locoregional relapse. There was a significant difference in outcome in terms of OS and DFS in favor of single node positivity when compared with 2-3 node positivity (5 year DFS 94.4% vs. 83.5 %, p = 0.000017, 5 year OS 96.6% vs. 89.1%, p = 0.00023). There was no difference in OS and DFS between patients who received adjuvant RT and patients who did not.
76% of the patients received adjuvant RT and there was no statistically significant difference in the outcome between those who received adjuvant RT and those who did not. Patients with single node positivity had better DFS and OS when compared with patients with 2-3 node positivity. The ongoing prospective trial (SUPREMO Trail) may give us further insight into the exact role for RT in patients with 1-3 node positivity.
Regional Cancer Centre, Trivandrum, India.
Has not received any funding.
All authors have declared no conflicts of interest.