Postoperative adjuvant radiation therapy in breast cancer patients with positive axillary lymph nodes :observation of 78 cases

Objective To determine the effect of postoperative adjuvant radiation therapy for breast cancer patients with T 1～3 and eight or more positive axillary lymph nodes. Methods Seventy eight patients treated between 1983 and 1991 in Cancer Hospital of Chinese Academy of Medical Science were retrospectively analyzed, All patients, with histologically confirmed invasive carcinomas of the breast, received half to four courses of adjuvant chemotherapy after radical surgery. Radiation therapy to the ipsilateral supraclavicular, infraclavicular and internal mammary nodes with or without chest wall and axillary nodes was given to 38 patients, the majority were treated to a dose of more than 45 Gy. Results For the radiation group and no radiation group, the five year initial locoregional recurrence rates were 30.8% and 57.4% (P=0.010), the disease free survival rates were 47.7% and 15.7%(P=0.002), the overall survival rates were 64.4% and 40.6%(P=0.083), respectively. The crude chest wall recurrence rate was 7.7% (2/26) for the patients who received chest wall irradiation as compared with 3/9 for the patients who did not receive chest wall irradiation. The crude axilla recurrence rate was 4.0% (1/25) for the patients who received axilla irradiation as compared with 7.7% (1/13) for the patients who did not received axilla irradiation. Conclusions Besides adjuvant chemotherapy, radiation therapy should be routinely given to the breast cancer patients with T 1～3 and eight or more positive axillary lymph nodes. In radiation therapy, chest wall should be one of the routine irradiated sites, axillary irradiation is not necessary.