The Role of Postmastectomy Radiation in Breast Cancer Patients with One to Three Positive Axillary Lymph Nodes

Background: Adjuvant radiotherapy in T1-T2 invasive breast carcinoma and 1-3 positive lymph nodes is controversial due to discrepancies in the reported locoregional recurrence risks and survival data. Purpose: This work aims to explore the effectiveness of postoperative radiation therapy in patients with 1-3 positive axillary lymph nodes treated by modified radical mastectomy with systemic chemotherapy with or without hormonal treatment on locoregional recurrence and survival rates. Patients and Methods: One hundred and thirteen breast cancer patients with T1 or T2 tumors and 1-3 positive axillary lymph nodes, treated by modified radical mastectomy were registered in Clinical Oncology and Nuclear Medicine Department of Mansoura Tanta University Hospitals in the period between January 1995 and December 1998. Of the 113 patients, 55 patients, received postoperative radiotherapy while 58 patients did not receive it. Results: Postoperative radiotherapy reduced the incidence of locoregional recurrence from 18.2% to 5.2% (p=0.03). Distant metastases was 22.4% in the radiotherapy group of patients in comparison to 40% (p=0.04). Disease free survival and overall survival were prolonged with postoperative radiotherapy received group (p=0.03, 0.05) respectively. The risk factors including tumor size, grading and number of dissected axillary lymph nodes were of statistically significant value regarding both locoregional recurrence rates and survivals on the univariate analysis. On multivariate analysis they were statistically significant regarding disease free and overall survivals. Conclusion: Postoperative radiotherapy significantly reduce locoregional recurrence and survival in patients with 1-3 positive axillary lymph nodes. Patients with high risk factors including tumors !2cm, grade III and inadequate lymph node dissection are more likely to benefit from radiotherapy.