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Radiotherapy to the Chest Wall Following Mastectomy for Node-Negative Breast Cancer: A Systematic Review
Radiother Oncol. 2009 Apr 1;91(1):23-32, NP Rowell
Trials using inadequate or orthovoltage radiotherapy were excluded. Data linking potential risk factors, either individually or in combination, to the occurrence of LRR(locoregional relapse ) were handled qualitatively. Data from randomised trials of post-mastectomy radiotherapy were included in a meta-analysis.
Baseline risk of LRR is increased in the presence of
- lymphovascular invasion
- grade 3 tumour
- tumours greater than 2 cm or a close resection margin
- in patients who are pre-menopausal or aged less than 50.
Those with no risk factors have a baseline risk of LRR of approximately 5% or less rising to a risk of 15% or more for those with two or more risk factors.
In the meta-analysis of three randomised trials of mastectomy and axillary clearance (667 patients), the addition of radiotherapy resulted in an 83% reduction in the risk of LRR (P
The use of post-mastectomy radiotherapy for women with node-negative breast cancer requires re-evaluation. Radiotherapy should be considered for those with two or more risk factors.