• Ryoichi Matsunuma, Masahiko Oguchi, Tomoko Fujikane, Masaaki Matsuura, Takehiko Sakai, Kiyomi Kimura, Hidetomo Morizono, Kotaro Iijima, Ayumi Izumori, Yumi Miyagi, Seiichiro Nishimura, Masujiro Makita, Naoya Gomi, Rie Horii, Futoshi Akiyama, and Takuji Iwase.
• Department of Surgery, Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan. r-matsunuma@nifty.com
• Int. J. Radiat. Oncol. Biol. Phys. 2012 Jul 1; 83 (3): 845-52.

PurposeThe indication for postmastectomy radiotherapy (PMRT) in breast cancer patients with one to three positive lymph nodes has been in discussion. The purpose of this study was to identify patient groups for whom PMRT may be indicated, focusing on varied locoregional recurrence rates depending on lymphatic invasion (ly) status.Methods And MaterialsRetrospective analysis of 1,994 node-positive patients who had undergone mastectomy without postoperative radiotherapy between January 1990 and December 2000 at our hospital was performed. Patient groups for whom PMRT should be indicated were assessed using statistical tests based on the relationship between locoregional recurrence rate and ly status.ResultsMultivariate analysis showed that the ly status affected the locoregional recurrence rate to as great a degree as the number of positive lymph nodes (p < 0.001). Especially for patients with one to three positive nodes, extensive ly was a more significant factor than stage T3 in the TNM staging system for locoregional recurrence (p < 0.001 vs. p = 0.295).ConclusionAmong postmastectomy patients with one to three positive lymph nodes, patients with extensive ly seem to require local therapy regimens similar to those used for patients with four or more positive nodes and also seem to require consideration of the use of PMRT.Copyright © 2012 Elsevier Inc. All rights reserved.

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