According to a study published in the Journal of Clinical Oncology, the pattern of cancer recurrence in node-negative women with large (at least 5 cm) breast tumors does not warrant the routine use of post-mastectomy radiation therapy.
A small subset of women with early-stage breast cancer have large breast tumors (tumors that are 5 centimeters in diameter or larger) but negative lymph nodes. Treatment of these women often involves surgery along with chemotherapy and/or hormonal therapy. The role of radiation therapy, however, is unclear.
Radiation therapy for breast cancer is a local therapy. It treats the affected breast and surrounding area but does not treat cancer that has already spread to other locations in the body.
To determine the likely benefit of radiation therapy among node-negative women with large breast tumors, researchers evaluated information from five clinical trials. These trials included 313 women with large tumors but negative lymph nodes. Three quarters of the women received chemotherapy and/or hormonal therapy. None of the women received post-mastectomy radiation therapy.
The researchers evaluated the patterns of cancer recurrence in the study participants. Recurrences were classified as local or regional if they involved the area around the breast and as distant if they involved other parts of the body.
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- Over a 10-year period, 7% of women had an isolated local or regional recurrence (a local or regional recurrence without a simultaneous distant recurrence). Overall, 10% of women had a local or regional recurrence.
- The rate of local or regional cancer recurrence was lower among women who received chemotherapy and/or hormonal therapy than among women who received neither.
- 24% of women had a distant cancer recurrence.
Given the low rate of local or regional cancer recurrence in this subset of breast cancer patients, the researchers conclude that postmastectomy radiation therapy “should not be routinely used for these patients.”
Reference: Taghian AG, Jeong J-H, Mamounas EP et al. Low Locoregional Recurrence Rate among Node-negative Breast Cancer Patients with Tumors 5 cm or Larger Treated by Mastectomy, with or without Adjuvant Systemic Therapy and Without Radiotherapy: Results from Five National Surgical Adjuvant Breast and Bowel Project Randomized Clinical Trials. Journal of Clinical Oncology. 2006;24:3927-3932.
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