Radiation therapy and survival in breast cancer patients with 10 or more positive axillary lymph nodes treated with mastectomy

Sami G. Diab, Susan G. Hilsenbeck, Carl de Moor, Gary M. Clark, C. K. Osborne, Peter M. Ravdin, Richard M. Elledge

Research output: Contribution to journalArticlepeer-review

66 Scopus citations


Purpose: Adjuvant loco-regional radiation (XRT) frequently is recommended after mastectomy and adjuvant systemic therapy in patients with 10 or more positive axillary lymph nodes (ALN) to reduce the high loco- regional failure rate observed in this subset. In this study, we explored the possibility that adjuvant loco-regional radiation therapy (LR-XRT) also could decrease distant failure and improve overall survival (OS) in this subset of poor-prognosis patients. Patients and Methods: Retrospectively, 618 breast patients with 10 or more positive ALN were studied. The median follow-up time was 7.5 years. All patients received systemic adjuvant therapy and 35% also received adjuvant radiation therapy. Loco-regional failure, distant failure, and OS analyses were adjusted far age, tumor size, number of positive ALN, and estrogen receptor (ER) status using Cox regression model. Results: As expected, patients had a very high risk of loco-regional and distant failure. At 5 years, 30% of patients had loco-regional failure as a first event and 54% had distant failure. Radiation dramatically reduced loco-regional failure (hazards rate ratios [RR] = 0.29; 95% confidence interval [CI], 0.19 to 0.45). The adjusted 5-year loco-regional failure rate was 13% with radiation and 38% without radiation (P = .0001). Radiation also was associated with improved distant control (RR = 0.75; 95% CI, 0.58 to 0.96). The adjusted 5- year distant failure rate was 48% with radiation and 58% without radiation (P = .02). OS also improved with radiation (RR = 0.68; 95% CI, 0.53 to 0.85). The adjusted 5-year OS was 56% with radiation and 42% without radiation (P = .001). Conclusion: In this cohort of high-risk breast cancer patients, XRT was associated with less loco-regional and distant failure and improved OS. This suggests that improved loco-regional control might decrease secondary systemic spread and improve survival.

Original languageEnglish (US)
Pages (from-to)1655-1660
Number of pages6
JournalJournal of Clinical Oncology
Issue number5
StatePublished - May 1998
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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