Radiotherapy to the Chest Wall Following Mastectomy for Node-Negative Breast Cancer

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.

Results.

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 < p =" 0.16).">

Conclusion.

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.