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Abstract
PURPOSE:
We compared the oncologic outcomes of breast-conserving surgery plus radiation therapy (BCS+RT) and modified radical mastectomy (MRM) under anthracycline plus taxane-based (AT) regimens and investigated the role of adjuvant radiation therapy (RT) in patients with pathologic N1 (pN1) breast cancer treated by mastectomy.

MATERIALS AND METHODS:
We retrospectively reviewed the medical records of 2,011 patients with pN1 breast cancer who underwent BCS+RT or MRM alone at 12 institutions between January 2006 and December 2010. Two-to-one propensity score matching was performed for balances in variables between the groups.

RESULTS:
The median follow-up duration for the total cohort was 69 months (range, 1 to 114 months). After propensity score matching, 1,074 patients (676 in the BCS+RT group and 398 in the MRM-alone group) were analyzed finally. The overall survival, disease-free survival, locoregional failure-free survival, and regional failure-free survival (RFFS) curves of the BCS+RT group vs. MRM-alone group were not significantly different. The subgroup analysis revealed that in the group with both lymphovascular invasion (LVI) and histologic grade (HG) III, the BCS+RT showed significantly superior RFFS (p=0.008). Lymphedema (p=0.007) and radiation pneumonitis (p=0.031) occurred more frequently in the BCS+RT group than in the MRM-alone group, significantly.

CONCLUSION:
There are no differences in oncologic outcomes between BCS+RT and MRM-alone groups under the AT chemotherapy regimens for pN1 breast cancer. However, BCS+RT group showed superior RFFS to MRM-alone group in the patients with LVI and HG III. Adjuvant RT might be considerable for pN1 breast cancer patients with LVI and HG III.

Author information

Yoo GS1, Park W1, Yu JI1, Choi DH1, Kim YJ2, Shin KH3, Wee CW3, Kim K4, Park KR5, Kim YB6, Ahn SJ7, Lee JH8, Kim JH9, Chun M10, Lee HS11, Kim JS12, Cha J13.
1
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2
Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
3
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
4
Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
5
Department of Radiation Oncology, Kosin University Gospel Hospital, Busan, Korea.
6
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
7
Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea.
8
Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
9
Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
10
Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.
11
Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan, Korea.
12
Department of Radiation Oncology, Chonbuk National University Medical School, Jeonju, Korea.
13
Department of Radiation Oncology, Wonju Severance Christian Hospital, Wonju, Korea.