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The Effect of Adjuvant Radiotherapy on Mortality Differs According to Primary Tumor Location in Women with Node-Positive Breast Cancer

Die Wirkung der adjuvanten Strahlentherapie auf das Letalitätsrisiko variiert je nach Tumorsitz bei Patientinnen mit einem nodal positiven Mammakarzinom

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Purpose:

To evaluate the prognostic significance of primary tumor location and to examine whether the effect of adjuvant radiotherapy on survival varies according to tumor location in women with axillary node-positive (ALN+) breast cancer (BC).

Patients and Methods:

Data were abstracted from the SEER database for 24,410 women aged 25–95 years, diagnosed between 1988–1997 with nonmetastatic T1–T2, ALN+ BC. Subgroup analyses were performed using interactions within proportional hazards models. Event was defined as death from any cause. Prognostic variables were selected using Akaike Information Criteria. Joint significances of subgroups were evaluated with Wald test.

Results:

Median follow-up was 10 years. In joint models, statistically significant interactions were found between tumor location, nodal involvement, type of surgery, and radiotherapy. Factorial presentation of interactions showed consistent 13% proportional reduction of mortality in all subgroups, except in women with medial tumors with ≥ 4 ALN+ treated with mastectomy. In this subgroup, use of radiotherapy was associated with a 16% proportional increase in mortality.

Conclusion:

Medial tumor location is a significant adverse prognostic factor that should be considered in treatment decision- making for women with ALN+ BC. Improved survival was observed with radiotherapy use in all subgroups, except in women with medial tumors with ≥ 4 ALN+ treated with postmastectomy radiotherapy. These findings raise concern that the favorable effect of radiotherapy may be offset by excess toxicities in the latter subgroup.

Ziel:

Untersuchung der prognostischen Bedeutung der intramammären Tumorlokalisation beim nodal positiven Mammakarzinom und Evaluation des Einflusses einer adjuvanten Strahlentherapie in Abhängigkeit von der Tumorlokalisation.

Patienten und Methodik:

Die Daten von 24 410 Patientinnen im Alter von 25–95 Jahren mit Erstdiagnose eines Mammakarzinoms T1–T2 N1–3 M0 in den Jahren 1988–1997 wurden der SEER-Datenbank entnommen. Subgruppenanalysen wurden auf der Grundlage von Interaktionstests durchgeführt. Als Zensurereignisse wurden Todesfälle jeglicher Ursache zugrunde gelegt. Prognostische Kovariaten wurden anhand der Akaike-Kriterien ausgewählt.

Ergebnisse:

Die mediane Nachbeobachtungszeit betrug 10 Jahre. In gemeinsamen Rechenmodellen wurden signifikante Interaktionen zwischen Tumorlokalisation, axillärem Lymphknotenstatus, Operationsart und Strahlentherapie festgestellt. Die faktorielle Verarbeitung der Interaktionen bestätigte eine konsistente Senkung des Letalitätsrisikos durch eine adjuvante Strahlentherapie um 13% in allen untersuchten Subgruppen außer bei Patientinnen mit einem medialen Tumorsitz mit mehr als drei Lymphknotenmetastasen nach Mastektomie. In diesem Patientinnenkollektiv führte die Strahlentherapie zu einer relativen Letalitätserhöhung um 16%.

Schlussfolgerung:

Medialer Tumorsitz ist ein signifikanter negativer Prognosefaktor bei Patientinnen mit einem nodal positiven Mammakarzinom und sollte in die Therapieentscheidung dieser Patientinnen mit einbezogen werden. Eine Mortalitätssenkung durch eine adjuvante Strahlentherapie konnte für alle Patientinnen außer jene mit einem medialen Tumorsitz mit vier und mehr Lymphknotenmetastasen nach Mastektomie nachgewiesen werden. Diese Ergebnisse geben Anlass zu der Spekulation, dass die therapieassoziierte Morbidität der Strahlentherapie bei diesen Patientinnen den Therapievorteil der Radiotherapie übersteigen könnte.

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Authors and Affiliations

  1. Oncology Center, UZ Brussel, Jette, Belgium

    Vincent Vinh-Hung, Guy Soete & Guy Storme

  2. British Columbia Cancer Agency, Victoria, BC, Canada

    Pauline T. Truong

  3. University Hospital, Heinrich Heine University, Düsseldorf, Germany

    Wolfgang Janni

  4. Radiation Oncology, University of Arizona, Tucson, AZ, USA

    Nam Phong Nguyen

  5. Geneva University Hospitals, Geneva, Switzerland

    Georges Vlastos & Sabine Balmer-Majno

  6. Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary

    Gábor Cserni

  7. University of New Mexico Cancer Research and Treatment Center, Albuquerque, NM, USA

    Melanie E Royce MD, PhD

  8. University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Wendy A. Woodward

  9. Decision Analysis, Burlington, VT, USA

    Donald Promish

  10. Allan Blair Cancer Centre, Regina, Saskatchewan, Canada

    Patricia Tai

  11. Polyclinic of Courlancy, Reims, France

    Bruno Cutuli

  12. Geneva Cancer Registry, Geneva, Switzerland

    Christine Bouchardy

  13. Associate Professor of Medicine, UMM Cancer Research and Treatment Center, 900 Camino de Salud N.E., MSC 08-4630, Albuquerque, NM, 87131-0001, USA

    Melanie E Royce MD, PhD

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  1. Vincent Vinh-Hung
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  2. Pauline T. Truong
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  3. Wolfgang Janni
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  4. Nam Phong Nguyen
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  5. Georges Vlastos
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  6. Gábor Cserni
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  7. Melanie E Royce MD, PhD
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  9. Donald Promish
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  10. Patricia Tai
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  11. Guy Soete
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  13. Bruno Cutuli
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  14. Guy Storme
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  15. Christine Bouchardy
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Corresponding author

Correspondence to Melanie E Royce MD, PhD.

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Vinh-Hung, V., Truong, P.T., Janni, W. et al. The Effect of Adjuvant Radiotherapy on Mortality Differs According to Primary Tumor Location in Women with Node-Positive Breast Cancer. Strahlenther Onkol 185, 161–168 (2009). https://doi.org/10.1007/s00066-009-1921-z

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