Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minamiumemoto-Machi, Matsuyama, Ehime, Japan.
Breast Cancer. 2013 Jul;20(3):218-22. doi: 10.1007/s12282-011-0331-0. Epub 2012 Feb 15.
There is still controversy concerning the indication of postmastectomy radiotherapy (PMRT) for pT3N0M0 breast cancer. To identify the candidates for PMRT in this subset, we investigated failure patterns, and searched for risk factors for isolated locoregional failure in pT3N0M0 breast cancer after mastectomy without PMRT.
Among 1,176 patients who received mastectomy without PMRT for untreated unilateral breast cancer between 1990 and 2002, 64 patients (5%) had pT3N0M0 breast cancer (age 30-81 years; median 52.5 years).
Isolated locoregional failure as the initial failure occurred in three patients. For all 64 patients, the 8-year failure-free survival rate, the isolated locoregional failure-free rate, and the distant failure-free rate were 76, 93, and 82%, respectively. Incidence of isolated locoregional failure as the initial failure was 18% (2/11) for patients 40 years or younger and 2% (1/53) for patients older than 40 years. The 8-year isolated locoregional failure-free rates were 73% for patients 40 years or younger and 98% for patients older than 40 years (p = 0.0135).
Concerning pT3N0M0 breast cancer, incidence of isolated locoregional failure was comparatively low after mastectomy without PMRT. Routine use of PMRT for all pT3N0M0 patients seemed to be unacceptable. PMRT may be useful for younger patients because of the comparatively high incidence of isolated locoregional failure. Because of the small number of cases in our series, further studies are necessary to determine the usefulness of PMRT for younger patients with pT3N0M0 breast cancer.
对于 pT3N0M0 乳腺癌患者，保乳手术后放疗（PMRT）的适应证仍存在争议。为了确定这部分患者中 PMRT 的适用人群，我们研究了失败模式，并寻找了保乳手术后未行 PMRT 的 pT3N0M0 乳腺癌患者孤立局部区域复发的危险因素。
1990 年至 2002 年间，有 1176 例未经治疗的单侧乳腺癌患者接受了保乳手术而未行 PMRT，其中 64 例（5%）患有 pT3N0M0 乳腺癌（年龄 30-81 岁；中位年龄 52.5 岁）。
三名患者以孤立的局部区域复发作为初始失败。对于所有 64 例患者，8 年无失败生存率、孤立局部区域无失败生存率和远处无失败生存率分别为 76%、93%和 82%。40 岁及以下患者中孤立局部区域复发作为初始失败的发生率为 18%（2/11），而 40 岁以上患者的发生率为 2%（1/53）。40 岁及以下患者 8 年的孤立局部区域无失败率为 73%，而 40 岁以上患者为 98%（p=0.0135）。
对于 pT3N0M0 乳腺癌患者，保乳手术后未行 PMRT 后孤立局部区域复发的发生率较低。对所有 pT3N0M0 患者常规应用 PMRT 似乎并不可取。对于年轻患者，PMRT 可能有用，因为孤立的局部区域复发发生率较高。由于本研究中病例数较少，需要进一步研究以确定 PMRT 对年轻的 pT3N0M0 乳腺癌患者的作用。
