The Cambridge post-mastectomy radiotherapy (C-PMRT) index: A practical tool for patient selection |
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Authors: | Mukesh B. Mukesh Simon Duke Deepak Parashar Gordon Wishart Charlotte E. Coles Charles Wilson |
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Affiliation: | 1. Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, UK;2. Cambridge Cancer Trials Centre, Cambridge Clinical Trials Unit – Cancer Theme Department of Oncology, University of Cambridge, Addenbrookes Hospital, UK;3. MRC Biostatistics Unit Hub in Trials Methodology Research, University Forvie Site, Cambridge, UK;4. Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge, UK;5. Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, UK |
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Abstract: | Background and purposePost mastectomy radiotherapy (PMRT) reduces loco-regional recurrence (LRR) and has been associated with survival benefit. It is recommended for patients with T3/T4 tumours and/or ?4 positive lymph nodes (LN). The role of PMRT in 1–3 positive LN and LN negative patients is contentious. The C-PMRT index has been designed for selecting PMRT patients, using independent prognostic factors for LRR. This study reports a 10 year experience using this index.Materials and methodsThe C-PMRT index was constructed using the following prognostic factors (a) number of positive LN/lymphovascular invasion, (b) tumour size (c) margin status and (d) tumour grade. Patients were categorised as high (H) risk, intermediate (I) risk and low (L) risk. PMRT was recommended for H and I risk patients. The LRR, distant metastasis and overall survival (OS) rates were measured from the day of mastectomy.ResultsFrom 1999 to 2009, 898 invasive breast cancers in 883 patients were treated by mastectomy (H: 323, I: 231 and L: 344). At a median follow up of 5.2 years, 4.7% (42/898) developed LRR. The 5-year actuarial LRR rates were 6%, 2% and 2% for the H, I and L risk groups, respectively. 1.6% (14/898) developed isolated LRR (H risk n = 4, I risk group n = 0 and L risk n = 10). The 5-year actuarial overall survival rates were 67%, 77% and 90% for H, I and L risk groups, respectively.ConclusionBased on published literature, one would have expected a higher LRR rate in the I risk group without adjuvant RT. We hypothesise that the I risk group LRR rates have been reduced to that of the L risk group by the addition of RT. Apart from LN status and tumour size, other prognostic factors should also be considered in selecting patients for PMRT. This pragmatic tool requires further validation. |
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Keywords: | Breast cancer Post-mastectomy radiotherapy |
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