Is Postmastectomy Radiation Therapy Indicated in Patients with Close or Positive Margins? ()
Affiliation(s)
1Surgical Oncology Service, Departments of General Surgery, Wake Forest Baptist School of Medicine, Winston-Salem, NC, USA.
2Department of Biostatistics, Wake Forest Baptist School of Medicine, Winston-Salem, NC, USA.
3Department of Radiation Oncology, Wake Forest Baptist School of Medicine, Winston-Salem, NC, USA.
ABSTRACT
Background: The indications for Post Mastectomy Radiation Therapy (PMRT)
for positive or close margins are unclear. We examined the indications for PMRT
in mastectomy patients with close or positive margins and determined patterns
for relapse and survival. Methods: The pathology reports of 610 patients
treated with a mastectomy from 1999-2012 were reviewed. Of these, 72 patients
had a positive or <2 mm margin. Demographic, tumor characteristics,
treatments and survival were compared between women treated with and without
PMRT. Results: The mean follow up was 4.1 years. Patients who received PMRT
were younger (p = 0.03) and more likely to receive chemotherapy (p = 0.03). Patients
with lymphovascular invasion (LVI) were more likely to undergo PMRT (p = 0.02).
Seven patients who did not receive PMRT recurred. There was no correlation with
locoregional failure. The disease free survival was better in the PMRT group (p
= 0.03), but the overall survival was the same. Conclusion: We found that women
with a close or positive margin who were younger, had LVI, and who received
chemotherapy received PMRT. The disease free survival was better in the PMRT
cohort, but the overall survival was similar. Long-term follow up of patients
is warranted to see if PMRT offers a survival advantage.
Share and Cite:
Bryan, M. , D’Agostino, R. , Brown, D. and Howard-McNatt, M. (2016) Is Postmastectomy Radiation Therapy Indicated in Patients with Close or Positive Margins?.
Advances in Breast Cancer Research,
5, 66-73. doi:
10.4236/abcr.2016.52007.