Postmastectomy Radiation and Adjuvant Systemic Therapy: Outcomes in High-Risk Women with Stage II?III Breast Cancer and Assessment of Clinical, Pathologic, and Treatment-Related Factors Influencing Local-Regional Control

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Abstract
Women with clinical T3 breast cancers, four or more positive axillary nodes, or both have a 25–35% risk of local‐regional failure after mastectomy with or without adjuvant Tamoxifen or chemotherapy. We analyze the effectiveness of adjuvant radiation therapy in altering this pattern of failure. From 1984 to 1993, 80 women were treated with postmastectomy radiation. Twenty‐three percent had operable T3 tumors and 71% were node positive (59%≥ 4 nodes). Sixty‐nine percent received adjuvant chemotherapy ± Tamoxifen and 21% received Tamoxifen alone. Radiation was directed to the chest wall (median 50 Gy) in all patients, supraclavicular region (median 46 Gy) in 73%, axilla (median 46 Gy) in 54%, and internal mammary nodes (median 50Gy) in 5%. Median follow‐up of surviving patients was 45 months (range 5–131 months). The 5‐year actuarial local and regional control rates were 98% and 99%, respectively. There have been no local failures as an isolated first event. Two women with chest wall failures had simultaneous or antecedent distant metastases. There was 1 supraclavicular failure and no axillary or internal mammary node failures. The 5‐year actuarial overall, cause‐specific and relapse‐free survival for women with clinical T3 tumors were 68%, 70%, and 68%, for women with 4–9 positive nodes were 66%, 80%, and 68%, and for women with ≥10 positive nodes were 49%, 56%, and 43%, respectively. Postmastectomy radiation was extremely effective in preventing local‐regional recurrences in high‐risk women. Overall and cause‐specific survival were excellent with this combined modality approach.

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