Cancer Research and Treatment

Original Articles

Comparison of Breast Conserving Surgery Followed by Radiation Therapy with Mastectomy Alone for Pathologic N1 Breast Cancer Patients in the Era of Anthracycline Plus Taxane-Based Chemotherapy: A Multicenter Retrospective Study (KROG 1418): Gyu Sang Yoo, Won Park, Jeong Il Yu, Doo Ho Choi, Yeon-Joo Kim, Kyung Hwan Shin, Chan Woo Wee, Kyubo Kim, Kyung Ran Park, Yong Bae Kim, Sung Ja Ahn, Jong Hoon Lee, Jin Hee Kim, Mison Chun, Hyung-Sik Lee, Jung Soo Kim, Jihye Cha; Cancer Res Treat. 2019;51(3):1041-1051. Published online November 1, 2018; DOI: https://doi.org/10.4143/crt.2018.424

Purpose
We compared the oncologic outcomes of breast-conserving surgery plus radiation therapy (BCS+RT) and modified radical mastectomy (MRM) under anthracycline plus taxane-based (AT) regimens and investigated the role of adjuvant radiation therapy (RT) in patients with pathologic N1 (pN1) breast cancer treated by mastectomy.
Materials and Methods
We retrospectively reviewed the medical records of 2,011 patients with pN1 breast cancer who underwent BCS+RT or MRM alone at 12 institutions between January 2006 and December 2010. Two-to-one propensity score matching was performed for balances in variables between the groups.
Results
The median follow-up duration for the total cohort was 69 months (range, 1 to 114 months). After propensity score matching, 1,074 patients (676 in the BCS+RT group and 398 in the MRM-alone group) were analyzed finally. The overall survival, disease-free survival, locoregional failure-free survival, and regional failure-free survival (RFFS) curves of the BCS+RT group vs. MRM-alone group were not significantly different. The subgroup analysis revealed that in the group with both lymphovascular invasion (LVI) and histologic grade (HG) III, the BCS+RT showed significantly superior RFFS (p=0.008). Lymphedema (p=0.007) and radiation pneumonitis (p=0.031) occurred more frequently in the BCS+RT group than in the MRM-alone group, significantly.
Conclusion
There are no differences in oncologic outcomes between BCS+RT and MRM-alone groups under the AT chemotherapy regimens for pN1 breast cancer. However, BCS+RT group showed superior RFFS to MRM-alone group in the patients with LVI and HG III. Adjuvant RT might be considerable for pN1 breast cancer patients with LVI and HG III.

Citations

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Investigation of the clinical benefits of regular breath-holding training utilizing surface guided radiation therapy technology for patients with left breast cancer
Hongming Li, Zheng Miao, Jie Shen, Jianing Xiao, Zhiwei Yang, Wei Tian, Xiansong Sun, Zhen Zhou, Jing Shen, Jie Qiu
Journal of Radiation Research and Applied Sciences.2025; 18(2): 101393. CrossRef
21-gene recurrence score in predicting the outcome of postoperative radiotherapy in T1-2N1 luminal breast cancer after breast-conserving surgery
Shang-Jin Xie, Run-Jie Wang, San-Gang Wu, Fu-Xing Zhang
The Breast.2024; 74: 103679. CrossRef
Assessing Radiation Effects on Chemo-Treated BT20 and 4T1 Breast Cancer, and Neuroblastoma Cell Lines: A Study of Single and Multiple-Cell Ionization via Infrared Laser Trapping
Mulugeta S. Goangul, Daniel B. Erenso, Ying Gao, Li Chen, Kwame O. Eshun, Gisela Alvarez, Horace T. Crogman
Radiation.2024; 4(1): 85. CrossRef
Overall survival after mastectomy versus breast-conserving surgery with adjuvant radiotherapy for early-stage breast cancer: meta-analysis
Kiran K Rajan, Katherine Fairhurst, Beth Birkbeck, Shonnelly Novintan, Rebecca Wilson, Jelena Savović, Chris Holcombe, Shelley Potter
BJS Open.2024;[Epub] CrossRef
Radiotherapy dosimetry and radiotherapy related complications of immediate implant-based reconstruction after breast cancer surgery
Yu Zhang, Fuxiu Ye, Yun Teng, Jin Zheng, Chunlu Li, Ruilan Ma, Haichen Zhang
Frontiers in Oncology.2023;[Epub] CrossRef
Does Breast-Conserving Surgery with Radiotherapy have a Better Survival than Mastectomy? A Meta-Analysis of More than 1,500,000 Patients
Gabriel De la Cruz Ku, Manish Karamchandani, Diego Chambergo-Michilot, Alexis R. Narvaez-Rojas, Michael Jonczyk, Fortunato S. Príncipe-Meneses, David Posawatz, Salvatore Nardello, Abhishek Chatterjee
Annals of Surgical Oncology.2022; 29(10): 6163. CrossRef
Protocol for the postoperative radiotherapy in N1 breast cancer patients (PORT-N1) trial, a prospective multicenter, randomized, controlled, non-inferiority trial of patients receiving breast-conserving surgery or mastectomy
Tae Hoon Lee, Ji Hyun Chang, Bum-Sup Jang, Jae Sik Kim, Tae Hyun Kim, Won Park, Yong Bae Kim, Su Ssan Kim, Wonshik Han, Han-Byoel Lee, Kyung Hwan Shin
BMC Cancer.2022;[Epub] CrossRef
Risk factors to identify the indication for regional nodal irradiation in T1-2N1M0 breast cancer: A joint analysis of 4,243 real-world cases from two institutions
Guang-Yi Sun, Ge Wen, Yu-Jing Zhang, Yu Tang, Hao Jing, Hui Fang, Jian-Yang Wang, Jiang-Hu Zhang, Xu-Ran Zhao, Si-Ye Chen, Yong-Wen Song, Jing Jin, Yue-Ping Liu, Yuan Tang, Shu-Nan Qi, Ning Li, Bo Chen, Ning-Ning Lu, Ye-Xiong Li, Shu-Lian Wang
Frontiers in Oncology.2022;[Epub] CrossRef
Chemo-treated 4T1 breast cancer cells radiation response measured by single and multiple cell ionization using infrared laser trap
Endris Muhammed, Li Chen, Ying Gao, Daniel Erenso
Scientific Reports.2019;[Epub] CrossRef

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Survival and Functional Outcome after Treatment for Primary Base of Tongue Cancer: A Comparison of Definitive Chemoradiotherapy versus Surgery Followed by Adjuvant Radiotherapy: Sangjoon Park, Yeona Cho, Jeongshim Lee, Yoon Woo Koh, Se-Heon Kim, Eun Chang Choi, Hye Ryun Kim, Ki Chang Keum, Kyung Ran Park, Chang Geol Lee; Cancer Res Treat. 2018;50(4):1214-1225. Published online December 26, 2017; DOI: https://doi.org/10.4143/crt.2017.498

Abstract PDF PubReader ePub

Purpose
The purpose of this study was to compare the clinical and functional outcomes in patients with primary base of tongue (BOT) cancer who received definitive radiotherapy (RT) or surgery followed by radiotherapy (SRT).
Materials and Methods
Between January 2002 andDecember 2016, 102 patientswith stage I-IVB primary BOT cancer underwent either definitive RT (n=46) or SRT (n=56), and treatment outcomeswere compared between two groups. The expression of p16 was also analyzed.
Results
The RT group had more patients with advanced T stage (T3-4) disease (58.7% vs. 35.7%, p=0.021) and who received chemotherapy (91.3% vs. 37.5%, p < 0.001) than the SRT group. At a median followup of 36.9 months (range, 3.3 to 181.5 months), the 5-year overall survival (OS) and disease-free survival (DFS) were 75.5% and 68.7%, respectively. With respect to treatment group, the 5-year OS and DFS in the RT and SRT groups did not differ significantly (OS, 68.7% vs. 80.5%, p=0.601; DFS, 63.1% vs. 73.1%, p=0.653). In multivariate analysis, OS differed significantly according to p16 expression (p16-negative vs. p16- positive; hazard ratio [HR], 0.145; 95% confidence interval [CI], 0.025 to 0.853; p=0.033). Regarding DFS, p16 expression (p16-negative vs. p16-positive; HR, 0.164; 95% CI, 0.045 to 0.598; p=0.006) showed a significant effect in multivariate analysis. Functional defects (late grade ≥ 3 dysphagia or voice alteration) were more frequently reported in the SRT than in the RT group (16.1% vs. 2.2%, p=0.021).
Conclusion
Despite advanced disease, patients in the RT group showed comparable survival outcomes and better functional preservation than those in the SRT group.

Citations

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Full Title: Surgical Versus Non‐Surgical Treatment of Advanced Oropharyngeal Squamous Cell Carcinoma: A Systematic Review and Meta‐Analysis
Megan K. Scharner, Johnny M. Owen, Shaun A. Nguyen, Alexandra E. Kejner, Jason G. Newman, Emily Brennan, W. Greer Albergotti
Head & Neck.2025;[Epub] CrossRef
Treatment de‐escalation for HPV+ oropharyngeal cancer: A systematic review and meta‐analysis
Fausto Petrelli, Andrea Luciani, Antonio Ghidini, Sara Cherri, Paolo Gamba, Marta Maddalo, Paolo Bossi, Alberto Zaniboni
Head & Neck.2022; 44(5): 1255. CrossRef
Ginsenoside Rd inhibits migration and invasion of tongue cancer cells through H19/miR-675-5p/CDH1 axis
Lu CHANG, Dongxu WANG, Shaoning KAN, Ming HAO, Huimin LIU, Zhijing YANG, Qianyun XIA, Weiwei LIU
Journal of Applied Oral Science.2022;[Epub] CrossRef
Postoperative Concurrent Chemoradiotherapy Versus Radiotherapy Alone for Advanced Oral Cavity Cancer in the Era of Modern Radiation Techniques
Tae Hyung Kim, In-Ho Cha, Eun Chang Choi, Hye Ryun Kim, Hyung Jun Kim, Se-Heon Kim, Ki Chang Keum, Chang Geol Lee
Frontiers in Oncology.2021;[Epub] CrossRef
Superficial circumflex iliac artery perforator flap for tongue reconstruction after hemiglossectomy for cancer: A case report
Hong Loi Nguyen, Truong Phu M. Ho, Xuan Phu Tran, Thanh Xuan Nguyen
Oral and Maxillofacial Surgery Cases.2021; 7(2): 100219. CrossRef
Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy
Ambika Parmar, Michaelina Macluskey, Niall Mc Goldrick, David I Conway, Anne-Marie Glenny, Janet E Clarkson, Helen V Worthington, Kelvin KW Chan
Cochrane Database of Systematic Reviews.2021;[Epub] CrossRef
Larynx-preserving reconstruction after extended base of the tongue resection
Hideki Kadota, Junichi Fukushima, Sei Yoshida, Kenichi Kamizono, Muneyuki Masuda, Satoshi Toh, Ryuji Yasumatsu, Torahiko Nakashima, Takashi Nakagawa
Journal of Plastic, Reconstructive & Aesthetic Surgery.2020; 73(4): 740. CrossRef

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Prognostic Impact of Elective Supraclavicular Nodal Irradiation for Patients with N1 Breast Cancer after Lumpectomy and Anthracycline Plus Taxane-Based Chemotherapy (KROG 1418): A Multicenter Case-Controlled Study: Haeyoung Kim, Won Park, Jeong Il Yu, Doo Ho Choi, Seung Jae Huh, Yeon-Joo Kim, Eun Sook Lee, Keun Seok Lee, Han-Sung Kang, In Hae Park, Kyung Hwan Shin, Chan Woo Wee, Kyubo Kim, Kyung Ran Park, Yong Bae Kim, Sung Ja Ahn, Jong Hoon Lee, Jin Hee Kim, Mison Chun, Hyung-Sik Lee, Jung Soo Kim, Jihye Cha; Cancer Res Treat. 2017;49(4):970-980. Published online January 4, 2017; DOI: https://doi.org/10.4143/crt.2016.382

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study was conducted to evaluate the impact of supraclavicular lymph node radiotherapy (SCNRT) on N1 breast cancer patients receiving post-lumpectomy whole-breast irradiation (WBI) and anthracycline plus taxane-based (AT) chemotherapy.
Materials and Methods
We performed a case-control analysis to compare the outcomes of WBI and WBI plus SCNRT (WBI+SCNRT). Among 1,147 patients with N1 breast cancer who received post-lumpectomy radiotherapy and AT-based chemotherapy in 12 hospitals, 542 were selected after propensity score matching. Patterns of failure, disease-free survival (DFS), distant metastasis-free survival (DMFS), and treatment-related toxicity were compared between groups.
Results
A total of 41 patients (7.6%) were found to have recurrence. Supraclavicular lymph node (SCN) failure was detected in three patients, two in WBI and one in WBI+SCNRT. All SCN failures were found simultaneously with distant metastasis. There was no significant difference in patterns of failure or survival between groups. The 5-year DFS and DMFS for patients with WBI and WBI+SCNRT were 94.4% versus 92.6% (p=0.50) and 95.1% versus 94.5% (p=0.99), respectively. The rates of lymphedema and radiation pneumonitis were significantly higher in the WBI+SCNRT than in the WBI.
Conclusion
We did not find a benefit of SCNRT for N1 breast cancer patients receiving AT-based chemotherapy.

Citations

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Patient-Reported Outcomes Between Whole-Breast Plus Regional Irradiation and Whole-Breast Irradiation Only in pN1 Breast Cancer After Breast-Conserving Surgery and Taxane-Based Chemotherapy: A Randomized Phase 3 Clinical Trial (KROG 17-01)
Nalee Kim, Won Park, Haeyoung Kim, Won Kyung Cho, Sung Ja Ahn, Mi Young Kim, Shin-Hyung Park, Ik Jae Lee, Inbong Ha, Jin Hee Kim, Tae Hyun Kim, Kyu Chan Lee, Hyung-Sik Lee, Tae Gyu Kim, Kyung Hwan Shin, Jong Hoon Lee, Jinhong Jung, Oyeon Cho, Yong Bae Kim
International Journal of Radiation Oncology*Biology*Physics.2025; 121(2): 341. CrossRef
De-escalation of regional nodal irradiation fields in pT1-2N1 breast cancer patients after breast conserving surgery: retrospective real-world clinical experience
Ji Hyun Hong, Jin-Ho Song, Kyu-Hye Choi, Shin Woo Kim, Woo-Chan Park, Jieun Lee, Ahwon Lee, Jun Kang, Byung-Ock Choi
Frontiers in Oncology.2025;[Epub] CrossRef
The optimal regional irradiation volume for breast cancer patients: A comprehensive systematic review and network meta-analysis of published studies
Wei-Xiang Qi, Lu Cao, Cheng Xu, Gang Cai, Jiayi Chen
Frontiers in Oncology.2023;[Epub] CrossRef
Protocol for the postoperative radiotherapy in N1 breast cancer patients (PORT-N1) trial, a prospective multicenter, randomized, controlled, non-inferiority trial of patients receiving breast-conserving surgery or mastectomy
Tae Hoon Lee, Ji Hyun Chang, Bum-Sup Jang, Jae Sik Kim, Tae Hyun Kim, Won Park, Yong Bae Kim, Su Ssan Kim, Wonshik Han, Han-Byoel Lee, Kyung Hwan Shin
BMC Cancer.2022;[Epub] CrossRef
What Is High-risk Breast Cancer With Pathologically Negative Lymph Nodes for Regional Recurrence?
Sang-Won Kim, Won Kyung Cho, Doo Ho Choi, Haeyoung Kim, Oyeon Cho, Won Park, Mison Chun
International Journal of Radiation Oncology*Biology*Physics.2021; 111(4): 992. CrossRef
Regional nodal irradiation in pT1-2N1 breast cancer patients treated with breast-conserving surgery and whole breast irradiation
Shin-Hyung Park, Jae-Chul Kim
Radiation Oncology Journal.2020; 38(1): 44. CrossRef
Prediction of nodal staging in breast cancer patients with 1-2 sentinel nodes in the Z0011 era
Fabio Corsi, Luca Sorrentino, Sara Albasini, Daniela Bossi, Carlo Morasso, Laura Villani, Marta Truffi
Medicine.2020; 99(35): e21721. CrossRef
Locoregional recurrence patterns in women with breast cancer who have not undergone post-mastectomy radiotherapy
Xuran Zhao, Yu Tang, Shulian Wang, Yong Yang, Hui Fang, Jianyang Wang, Hao Jing, Jianghu Zhang, Guangyi Sun, Siye Chen, Jing Jin, Yongwen Song, Yueping Liu, Bo Chen, Shunan Qi, Ning Li, Yuan Tang, Ningning Lu, Hua Ren, Yexiong Li
Radiation Oncology.2020;[Epub] CrossRef
Comparison of Dose Distribution in Regional Lymph Nodes in Whole-Breast Radiotherapy vs. Whole-Breast Plus Regional Lymph Node Irradiation: An In Silico Planning Study in Participating Institutions of the Phase III Randomized Trial (KROG 1701)
Haeyoung Kim, Heejung Kim, Won Park, Jong Yun Baek, Sung Ja Ahn, Mi Young Kim, Shin-Hyung Park, Ik Jae Lee, Inbong Ha, Jin Hee Kim, Tae Hyun Kim, Kyu Chan Lee, Hyung-Sik Lee, Tae Gyu Kim, Jin Ho Kim, Jong Hoon Lee, Jinhong Jung, Oyeon Cho, Jee Suk Chang,
Cancers.2020; 12(11): 3261. CrossRef
Clinical Significance of Lymph-Node Ratio in Determining Supraclavicular Lymph-Node Radiation Therapy in pN1 Breast Cancer Patients Who Received Breast-Conserving Treatment (KROG 14-18): A Multicenter Study
Jaeho Kim, Won Park, Jin Kim, Doo Choi, Yeon-Joo Kim, Eun Lee, Kyung Shin, Jin Kim, Kyubo Kim, Yong Kim, Sung-Ja Ahn, Jong Lee, Mison Chun, Hyung-Sik Lee, Jung Kim, Jihye Cha
Cancers.2019; 11(5): 680. CrossRef
Breast Conservation Therapy Versus Mastectomy in Patients with T1-2N1 Triple-Negative Breast Cancer: Pooled Analysis of KROG 14-18 and 14-23
Kyubo Kim, Hae Jin Park, Kyung Hwan Shin, Jin Ho Kim, Doo Ho Choi, Won Park, Seung Do Ahn, Su Ssan Kim, Dae Yong Kim, Tae Hyun Kim, Jin Hee Kim, Jiyoung Kim
Cancer Research and Treatment.2018; 50(4): 1316. CrossRef

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Postmastectomy Radiotherapy in Patients with pT1-2N1 Breast Cancer Treated with Taxane-Based Chemotherapy: A Retrospective Multicenter Analysis (KROG 1418): Yeon-Joo Kim, Won Park, Boram Ha, Boram Park, Jungnam Joo, Tae Hyun Kim, In Hae Park, Keun Seok Lee, Eun Sook Lee, Kyung Hwan Shin, Haeyoung Kim, Jeong Il Yu, Doo Ho Choi, Seung Jae Huh, Chan Woo Wee, Kyubo Kim, Kyung Ran Park, Yong Bae Kim, Sung Ja Ahn, Jong Hoon Lee, Jin Hee Kim, Mison Chun, Hyung-Sik Lee, Jung Soo Kim, Jihye Cha; Cancer Res Treat. 2017;49(4):927-936. Published online December 26, 2016; DOI: https://doi.org/10.4143/crt.2016.508

Abstract PDF Supplementary Material PubReader ePub

Purpose
The purpose of this study was to evaluate the impact of postmastectomy radiotherapy (PMRT) on loco-regional recurrence-free survival (LRRFS), disease-free survival (DFS), and overall survival (OS) in pT1-2N1 patients treated with taxane-based chemotherapy.
Materials and Methods
We retrospectively reviewed the medical data of pathological N1 patients who were treated with modified radical mastectomy and adjuvant taxane-based chemotherapy in 12 hospitals between January 2006 and December 2010.
Results
We identified 714 consecutive patients. The median follow-up duration was 69 months (range, 1 to 114 months) and the 5-year LRRFS, DFS, and OS rates were 97%, 94%, and 98%, respectively, in patients who received PMRT (PMRT [+]). The corresponding figures were 96%, 90%, and 96%, respectively, in patients who did not receive PMRT (PMRT [–]). PMRT had no significant impact on survival. Upon multivariable analysis, only the histological grade (HG) was statistically significant as a prognostic factor for LRRFS and DFS. In a subgroup analysis of HG 3 patients, PMRT (+) showed better DFS (p=0.081).
Conclusion
PMRT had no significant impact on LRRFS, DFS, or OS in pT1-2N1 patients treated with taxane-based chemotherapy. PMRT showed a marginal benefit for DFS in HG 3 patients. Randomized studies are needed to confirm the benefit of PMRT in high risk patients, such as those with HG 3.

Citations

Citations to this article as recorded by

Does Post-Mastectomy Radiotherapy Confer Survival Benefits on Patients With 1-3 Clinically Positive Lymph Nodes Rendered Pathologically Negative After Neoadjuvant Systemic Chemotherapy: Consensus from A Pooled Analysis?
Munaser Alamoodi
European Journal of Breast Health.2024; 20(2): 81. CrossRef
Effect of postmastectomy radiotherapy on T1-2N1M0 triple-negative breast cancer
Lin-Yu Xia, Wei-Yun Xu, Yan Zhao, Sudeep Gupta
PLOS ONE.2022; 17(6): e0270528. CrossRef
Suggestion for the omission of post-mastectomy chest wall radiation therapy in patients who underwent skin-sparing/nipple-sparing mastectomy
Nalee Kim, Won Park, Won Kyung Cho, Hae Young Kim, Doo Ho Choi, Seok Jin Nam, Seok Won Kim, Jeong Eon Lee, Jonghan Yu, Byung Joo Chae, Se Kyung Lee, Jai Min Ryu, Goo-Hyun Mun, Jai-Kyong Pyon, Byung-Joon Jeon
The Breast.2022; 66: 54. CrossRef
Post-mastectomy radiation therapy in breast cancer patients with 1–3 positive lymph nodes: No one size fits all
Majd Kayali, Joseph Abi Jaoude, Arafat Tfayli, Nagi El Saghir, Philip Poortmans, Youssef H. Zeidan
Critical Reviews in Oncology/Hematology.2020; 147: 102880. CrossRef
The survival benefit of postmastectomy radiotherapy for breast cancer patients with T1-2N1 disease according to molecular subtype
Jinli Wei, Yizhou Jiang, Zhimin Shao
The Breast.2020; 51: 40. CrossRef
The effect of postmastectomy radiotherapy in node-positive triple-negative breast cancer
Lei Zhang, Ru Tang, Jia-Peng Deng, Wen-Wen Zhang, Huan-Xin Lin, San-Gang Wu, Zhen-Yu He
BMC Cancer.2020;[Epub] CrossRef
Comparison of Breast Conserving Surgery Followed by Radiation Therapy with Mastectomy Alone for Pathologic N1 Breast Cancer Patients in the Era of Anthracycline Plus Taxane-Based Chemotherapy: A Multicenter Retrospective Study (KROG 1418)
Gyu Sang Yoo, Won Park, Jeong Il Yu, Doo Ho Choi, Yeon-Joo Kim, Kyung Hwan Shin, Chan Woo Wee, Kyubo Kim, Kyung Ran Park, Yong Bae Kim, Sung Ja Ahn, Jong Hoon Lee, Jin Hee Kim, Mison Chun, Hyung-Sik Lee, Jung Soo Kim, Jihye Cha
Cancer Research and Treatment.2019; 51(3): 1041. CrossRef
Effect of postmastectomy radiotherapy on triple-negative breast cancer with T1-2 and 1-3 positive axillary lymph nodes: a population-based study using the SEER 18 database
Jie Zhang, Xiao-Xiao Wang, Jun-Yu Lian, Chuan-Gui Song
Oncotarget.2019; 10(50): 5245. CrossRef
Local and regional recurrence following mastectomy in breast cancer patients with 1–3 positive nodes: implications for postmastectomy radiotherapy volume
Shin-Hyung Park, Jeeyeon Lee, Jeong Eun Lee, Min Kyu Kang, Mi Young Kim, Ho Yong Park, Jin Hyang Jung, Yee Soo Chae, Soo Jung Lee, Jae-Chul Kim
Radiation Oncology Journal.2018; 36(4): 285. CrossRef

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Incorporating Risk Factors to Identify the Indication of Post-mastectomy Radiotherapy in N1 Breast Cancer Treated with Optimal Systemic Therapy: A Multicenter Analysis in Korea (KROG 14-23): Hae Jin Park, Kyung Hwan Shin, Jin Ho Kim, Seung Do Ahn, Ja Young Kim, Won Park, Yong Bae Kim, Yeon-joo Kim, Jin Hee Kim, Kyubo Kim, Kyung Ran Park, Hyun Soo Shin, Bae Kwon Jeong, Sun Young Lee, Suzy Kim; Cancer Res Treat. 2017;49(3):739-747. Published online October 19, 2016; DOI: https://doi.org/10.4143/crt.2016.405

Abstract PDF Supplementary Material PubReader ePub

Purpose
In a recent meta-analysis, post-mastectomy radiotherapy (PMRT) reduced any first recurrence (AFR) and improved survival in N1 and N2 patients. We investigated risk factors for AFR in N1 after optimal systemic therapy without PMRT, to define a subgroup of patients who may benefit from PMRT.
Materials and Methods
One thousand three hundred eighty-two pT1-2N1M0 breast cancer patients treated with mastectomy without PMRT between 2005 and 2010 were retrospectively analyzed. Only 0.6% had no systemic therapy.
Results
After a median follow-up of 5.9 years, there were 173 AFR (53 loco-regional recurrence [LRR] without distant metastases [DM], 38 LRR with DM, and 82 DM without LRR). The 5-year LRR and AFR rates were 6.1% and 12.0%, respectively. Multivariate analysis revealed that close resection margin (p=0.001) was the only independent risk factor for LRR. Multivariate analysis for AFR revealed that age < 35 years (p=0.025), T2 stage (p=0.004), high tumor grade (p=0.032), close resection margin (p=0.035), and triple-negative biological subtype (p=0.031) were independent risk factors. Two or three positive lymph nodes (p=0.078) were considered a marginally significant factor. When stratified by these six factors, the 5-year LRR rates were 3.6% with 0-1 (n=606), 7.5% with 2-3 (n=655), and 12.7% with 4-6 (n=93) risk factors. The 5-year AFR rates were 7.1% with 0-1, 15.0% with 2-3, and 24.5% with 4-6 risk factors.
Conclusion
Patients with pT1-2N1M0 breast cancer who underwent mastectomy and optimal systemic therapy showed excellent loco-regional control and disease control. The patients with four or more risk factors may benefit from PMRT, and those with two or three risk factors merit consideration of PMRT.

Citations

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Clinical treatment score Post-5 Years (CTS5) predicts the benefit of postmastectomy radiotherapy in patients with T1-2N1 luminal breast cancer
Ke Liu, Guan-Qiao Li, Si-Qi Li, Xue-Qin Chen, San-Gang Wu
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Long Jin, Qifan Zhao, Shenbo Fu, Yuan Zhang, Shuhan Wu, Xiao Li, Fei Cao
Frontiers in Endocrinology.2024;[Epub] CrossRef
Assessment of Postmastectomy Radiation Therapy Receipt by Age and Association With Outcomes in Women With Breast Cancer
Carolina E. Fasola, Elaina Graham, Wei Sha, Courtney R. Schepel, Sally J. Trufan, Anna Hecksher, Richard L. White, Lejla Hadzikadic-Gusic
Clinical Breast Cancer.2024; 24(5): e396. CrossRef
The significance of risk stratification through nomogram-based assessment in determining postmastectomy radiotherapy for patients diagnosed with pT1 − 2N1M0 breast cancer
Chao Wei, Jie Kong, Huina Han, Xue Wang, Zimeng Gao, Danyang Wang, Andu Zhang, Jun Zhang, Zhikun Liu
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Development and validation of nomograms for predicting survival outcomes in patients with T1-2N1 breast cancer to identify those who could not benefit from postmastectomy radiotherapy
Hongyu Pu, Yunbo Luo, Linxing Zhang, Xin Li, Fangwei Li, Jingtai Chen, Shuangqiang Qian, Yunhui Tang, Xiaobo Zhao, Lingmi Hou, Yanchun Gao
Frontiers in Oncology.2023;[Epub] CrossRef
Postmastectomy radiotherapy in patients with T1-2N1 breast cancer: a single center experience and a meta-analysis
Meng Luo, Yao Jin, Chunjing Xu, Huihui Chen, Kun Zhang, Qiang Chen, Chencan Jin, Jinglu Lu, Jing Wang, Jia Huang, Hao Deng, Weili Jin, Shu Zheng, Yiding Chen, Jiaojiao Zhou
Journal of Cancer Research and Clinical Oncology.2023; 149(12): 9979. CrossRef
Developing prompts from large language model for extracting clinical information from pathology and ultrasound reports in breast cancer
Hyeon Seok Choi, Jun Yeong Song, Kyung Hwan Shin, Ji Hyun Chang, Bum-Sup Jang
Radiation Oncology Journal.2023; 41(3): 209. CrossRef
The Role of Post-Mastectomy Radiotherapy in T1-2N1 Breast Cancer Patients: Propensity Score Matched Analysis
Kangpyo Kim, Won Park, Haeyoung Kim, Won Kyung Cho, Nalee Kim, Seok Jin Nam, Seok Won Kim, Jeong Eon Lee, Jonghan Yu, Byung Joo Chae, Se Kyung Lee, Jai Min Ryu
Cancers.2023; 15(22): 5473. CrossRef
Immediate breast reconstruction has no impact on the oncologic outcomes of patients treated with post-mastectomy radiation therapy: a comparative analysis based on propensity score matching
Nalee Kim, Haeyoung Kim, Won Park, Doo Ho Choi, Won Kyung Cho, Seok Jin Nam, Jeong Eon Lee, Seok Won Kim, Jonghan Yu, Sei Kyung Lee, Byung-Joon Jeon, Jai Kyong Pyon, Goo-Hyun Mun, Tae Gyu Kim
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Postmastectomy Radiation Therapy in Patients With Minimally Involved Lymph Nodes: A Review of the Current Data and Future Directions
Bum-Sup Jang, Kyung Hwan Shin
Journal of Breast Cancer.2022; 25(1): 1. CrossRef
Practical Model to Optimize the Strategy of Adjuvant Postmastectomy Radiotherapy in T1-2N1 Breast Cancer With Modern Systemic Therapy
Fei-Fei Xu, Lu Cao, Cheng Xu, Gang Cai, Shu-Bei Wang, Wei-Xiang Qi, Jia-Yi Chen
Frontiers in Oncology.2022;[Epub] CrossRef
Influence of age as a continuous variable on the prognosis of patients with pT1-2N1 breast cancer
Xu-Ran Zhao, Yu Tang, Hong-Fen Wu, Qi-Shuai Guo, Yu-Jing Zhang, Mei Shi, Jing Cheng, Hong-Mei Wang, Min Liu, Chang-Ying Ma, Ge Wen, Xiao-hu Wang, Hui Fang, Hao Jing, Yong-Wen Song, Jing Jin, Yue-Ping Liu, Bo Chen, Shu-Nan Qi, Ning Li, Yuan Tang, Ning-Ning
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Suggestion for the omission of post-mastectomy chest wall radiation therapy in patients who underwent skin-sparing/nipple-sparing mastectomy
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Indian Journal of Cancer.2017; 54(1): 352. CrossRef

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Optimal Adjuvant Treatment for Curatively Resected Thoracic Esophageal Squamous Cell Carcinoma: A Radiotherapy Perspective: Kyung Hwan Kim, Jee Suk Chang, Ji Hye Cha, Ik Jae Lee, Dae Joon Kim, Byoung Chul Cho, Kyung Ran Park, Chang Geol Lee; Cancer Res Treat. 2017;49(1):168-177. Published online June 23, 2016; DOI: https://doi.org/10.4143/crt.2016.142

Abstract PDF PubReader ePub

Purpose
The purpose of this study was to evaluate the benefits of adjuvant treatment for curatively resected thoracic esophageal squamous cell carcinoma (ESCC) and determine the optimal adjuvant treatments.
Materials and Methods
One hundred ninety-five patients who underwent a curative resection for thoracic ESCC between 1994 and 2014 were reviewed retrospectively. Postoperatively, the patients received no adjuvant treatment (no-adjuvant group, n=68), adjuvant chemotherapy (AC group, n=62), radiotherapy (RT group, n=41), or chemoradiotherapy (CRT group, n=24). Chemotherapy comprised cisplatin and 5-fluorouracil administration every 3 weeks. The median RT dose was 45.0 Gy (range, 34.8 to 59.4 Gy). The overall survival (OS), disease-free survival (DFS), locoregional recurrence (LRR), and distant metastasis (DM) rates were estimated.
Results
At a median follow-up duration of 42.2 months (range, 6.3 to 215.2 months), the 5-year OS and DFS were 37.6% and 31.4%, respectively. After adjusting for other clinicopathologic variables, the AC and CRT groups had a significantly better OS and DFS compared to the no-adjuvant group (p < 0.05). The LRR rate was significantly lower in the RT and CRT groups than in the no-adjuvant group (p < 0.05), whereas no significant difference was observed in the AC group. In the no-adjuvant and AC groups, 25% of patients received high-dose salvage RT due to LRR. The DM rates were similar. The anastomotic stenosis and leakage were similar in the treatment groups.
Conclusion
Adjuvant treatment might prolong survival after an ESCC resection, and RT contributes to a reduction of the LRR. Overall, the risks and benefits should be weighed properly when selecting the optimal adjuvant treatment.

Citations

Citations to this article as recorded by

The Society of Thoracic Surgeons/American Society for Radiation Oncology Updated Clinical Practice Guidelines on Multimodality Therapy for Locally Advanced Cancer of the Esophagus or Gastroesophageal Junction
Stephanie G. Worrell, Karyn A. Goodman, Nasser K. Altorki, Jonathan B. Ashman, Traves D. Crabtree, Jennifer Dorth, Scott Firestone, David H. Harpole, Wayne L. Hofstetter, Theodore S. Hong, Kalie Kissoon, Geoffrey Y. Ku, Daniela Molena, Joel E. Tepper, Tho
Practical Radiation Oncology.2024; 14(1): 28. CrossRef
The Society of Thoracic Surgeons/American Society for Radiation Oncology Updated Clinical Practice Guidelines on Multimodality Therapy for Locally Advanced Cancer of the Esophagus or Gastroesophageal Junction
Stephanie G. Worrell, Karyn A. Goodman, Nasser K. Altorki, Jonathan B. Ashman, Traves D. Crabtree, Jennifer Dorth, Scott Firestone, David H. Harpole, Wayne L. Hofstetter, Theodore S. Hong, Kalie Kissoon, Geoffrey Y. Ku, Daniela Molena, Joel E. Tepper, Tho
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Esophageal cancer: Treatment challenges and controversies
Piyush Kumar, Ankita Mehta
Journal of Current Oncology.2021; 4(1): 41. CrossRef
Radical esophagectomy for stage II and III thoracic esophageal squamous cell carcinoma followed by adjuvant radiotherapy with or without chemotherapy: Which is more beneficial?
Bingwen Zou, Yan Tu, Duwen Liao, Yong Xu, Jin Wang, Meijuan Huang, Li Ren, Jiang Zhu, Youling Gong, Yongmei Liu, Lin Zhou, Xiaojuan Zhou, Feng Peng, You Lu
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Hao-Nan Lin, Long-Qi Chen, Qi-Xin Shang, Yong Yuan, Yu-Shang Yang
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Jin Zhang, Shiyuan Liu, Danjie Zhang, Zhenchuan Ma, Liangzhang Sun
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Wenjie Ni, Junqiang Chen, Zefen Xiao, Shufei Yu, Wencheng Zhang, Zongmei Zhou, Dongfu Chen, Qinfu Feng, Xiaohui Chen, Yu Lin, Kunshou Zhu, Shugeng Gao, Qi Xue, Yousheng Mao, Guiyu Cheng, Kelin Sun, Xiangyang Liu, Dekang Fang
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Xiao-han Zhao, Duo Wang, Fang Wang, Shu-chai Zhu
Medicine.2018; 97(47): e13168. CrossRef
The impact of adjuvant therapies on patient survival and the recurrence patterns for resected stage IIa–IVa lower thoracic oesophageal squamous cell carcinoma
Yichun Wang, Liyang Zhu, Wanli Xia, Liming Wu, Fan Wang
World Journal of Surgical Oncology.2018;[Epub] CrossRef
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Yichun Wang, Li Zhang, Dongmei Ye, Wanli Xia, Jun Jiang, Xiumei Wang, Mingxia Zhang, Fan Wang
Oncology Letters.2018;[Epub] CrossRef
Pattern of lymph node metastasis in thoracic esophageal squamous cell carcinoma with poor differentiation
Jinling Zhang, Yuanyuan Liu, Fengyuan Che, Yi Luo, Wei Huang, Xueyuan Heng, Baosheng Li
Molecular and Clinical Oncology.2018;[Epub] CrossRef
Negative lymph node at station 108 is a strong predictor of overall survival in esophageal cancer
Jinling Zhang, Xueyuan Heng, Yi Luo, Luning Li, Haiyan Zhang, Fengyuan Che, Baosheng Li
Oncology Letters.2018;[Epub] CrossRef

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Surgery Alone Versus Surgery Followed by Chemotherapy and Radiotherapy in Resected Extrahepatic Bile Duct Cancer: Treatment Outcome Analysis of 336 Patients: Jung Ho Im, Jinsil Seong, Ik Jae Lee, Joon Seong Park, Dong Sup Yoon, Kyung Sik Kim, Woo Jung Lee, Kyung Ran Park; Cancer Res Treat. 2016;48(2):583-595. Published online July 22, 2015; DOI: https://doi.org/10.4143/crt.2015.091

Abstract PDF PubReader ePub

Purpose
This study analyzed the outcomes of patients with resected extrahepatic bile duct cancer (EHBDC) in order to clarify the role of adjuvant treatments in these patients.
Materials and Methods
A total of 336 patients with EHBDC who underwent curative resection between 2001 and 2010 were analyzed retrospectively. The treatment types were as follows: surgery alone (n=168), surgery with chemotherapy (CTx, n=90), surgery with radiotherapy (RT) alone (n=29), and surgery with chemoradiotherapy (CRT, n=49).
Results
The median follow-up period was 63 months. The 5-year rates of locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) for all patients were 56.5%, 59.7%, 36.6%, and 42.0%, respectively. In multivariate analysis, surgery with RT and CRT was a significant prognostic factor for LRFFS, and surgery with CTx was a significant prognostic factor for DMFS, and surgery with CTx, RT, and CRT was a significant prognostic factor for PFS (p < 0.05). Surgery with CTx and CRT showed association with superior OS (p < 0.05), and surgery with RT had marginal significance (p=0.078). In multivariate analysis of the R1 resection patients, surgery with CRT showed significant association with OS (p < 0.05).
Conclusion
Adjuvant RT and CTx may be helpful in improving clinical outcomes of patients with resected EHBDC who have a high risk of disease recurrence, particularly R1 resection patients. Conduct of additional prospective, larger-scale studies will be required in order to confirm the benefit of adjuvant RT and CTx in these patients.

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Results of Definitive Radiation Therapy in Adenosquamous Cell Carcinoma of the Uterine Cervix: Sang Wook Lee, Chang Ok Suh, Eun Ji Chung, Gwi Eon Kim, Kyung Ran Park, Kang Kyoo Lee, Ik Jae Lee, Tchan Kyu Park, Jaewook Kim, Jong Taek Park, Jae Uk Shim, Joon Oh Park; J Korean Cancer Assoc. 2001;33(1):21-26.

Abstract PDF: PURPOSE
To define the clinical features and pattern of failure and to evaluate the results of radiation treatment in of adenosquamous cell carcinoma of the uterine cervix.
MATERIALS AND METHODS
From Jun. 1981 to Dec. 1997, 43 patients with adenosquamous cell carcinoma of the uterine cervix were retrospectively analyzed external radiation treatment and HDR-ICR from Yonsei cancer center and Wonju cristian hospital. The median age was 51. Stage distribution according to FIGO were stage 1b in 10, 2a in 5, 2b in 18, 3b in 9, 4a in 1. Median follow-up period was 41 months.
RESULTS
Overall survival rate and disease free survival rate were 57.2% and 60.2%. Complete response rate was 86.0%. Locoregional failure was observed in seven patients.
CONCLUSION
Major pattern of failure was locoregional failure. Adenosquamous cell carcinoma was not more aggressive than other pathologic types.

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Management of rocoregional recurrent breast cancer: Kyung Ran Park, Jong Young Lee, Chang Geol Lee, Chang Ok Suh, John Kyu Loh Juhn, Gwi Eon Kim, Soo Gon Kim, Won Yong Oh, Eun Hee Koh, Byung Soo Kim; J Korean Cancer Assoc. 1992;24(5):684-694.

Abstract PDF: No abstract available.

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Effectiveness of postoperative adjuvant treatment between radiation alone and chemotherapy plus radiation in locally advanced breast cancer: Kyung Ran Park, John Kyu Loh Juhn, Chang Ok Suh, Gwi Eon Kim, Eun Hee Koh, Byung Soo Kim, Kyung Sik Lee; J Korean Cancer Assoc. 1991;23(1):107-119.

Abstract PDF: No abstract available.

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Result of Definitive Irradiation for Regional Stage 4 Carcinoma of the Nasopharynx : An Analysis of the Patterns of Failure: Kwan Ho Cho, Soo Kon Kim, Kyung Ran Park, Mi Son Chun, Chang Ok Suh, Gwi Eon Kim, John J. K. Loh, Joo Hang Kim, Byung Soo Kim, Eun Hee Koh; J Korean Cancer Assoc. 1985;17(2):229-237.

Abstract PDF: Between January 1, 1971 and December 31, 1983, sixty three patients received radiotherapy for advanced (Stage IV) carcinoma of the nasopharynx confined to the head and neck at Yonsei University College of Medicine, Yonsei Cancer Center. Fifty seven of those 63 patients received at least 6,000 cGy. The 5 and 10 year actuarial survival rates were 21.8 and 13.1% and those median survival was 24 months. The actuarial survivals (median survival months) for Group 1 (16 who had sufficiently advanced primary tumor to qualify for Stage IV : T4 N0orl), Group 2 (34 who had sufficiently advanced adenopathy to qualify for Stage IV: T1-3N2or 3) and Group 3 ( 13 who had advanced both of primary and adenopathy: T4 N 2 or 3) were 9.7(19), 32.9(44) and 0%(9) respectively. The survival of the patients in Group 2 was better than that of those in either Group 1(p<0.005) or Group 3(p<0.001). Local persistence or recurrence of tumor in the nasopharynx was the primary cause of failure and occurred in 39.1%(18/46) of evaluable patents. Distant metastases was the next and occurred in 28.3%(13/46). There was a definite correlation between recurrence at primary site and T-stage; 61.5%(8/13) of evaluable Group 1 and 61.9%(13/21) of T 4 patients (Group 3 included) had local failure. Similary, failure in the neck (regional failure) correlated with N-stage, being 24%(9/25) for evaluable Group 2. The incidence of distant failure had no correlation with T-stage but correlated with N-stage; 40%(10/25) of Group 2 developed distant metastases. Treatment failure occured in 95%(36/38) of the patients by 2 years after therapy.

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Treatment Results of Non - operative Treatment Modality in Esophageal Cancer: John Juhn Kyu Loh, Kyung Ran Park, Chang Ok Suh, Chang Ok Suh, Seung Nok Hong, Byung Soo Kim; J Korean Cancer Assoc. 1988;20(2):143-153.

Abstract PDF: This report is a retrospective study of 99 patients with squamous cell carcinoma of the esophagus, treated with non-operative treatment modality (radiation therapy alone or chemotherapy and radiation therapy) or esophagectomy and radiation therapy+chemotherapy between January 1980 and December 1986. Of 99 patients, fifty three patients received definitive treatment as a curative intent and forty six patients received palliative treatment. Two year survival rate of definitive and palliative group was 24% (median survival of 11.3 months) and 1.5% (median survival of 4.4 months) respectively. Of 53 patients with definitive group, 33 patients were treated by radiation alone, 10 patients were treated by chemotherapy and radiation, and 10 patients were treated by esophagectomy and radiation+chemotherapy. Two year survival rate of radiation alone, chemother- apy and radaition, and esophagectomy and radiation+chemotherapy was 20/i, 33.6%, and 23% respectively. There wasno statistical significance in 2 year survival rate between non-operative and surgical group. Of 46 patients with palliative group, 33 patients (72%) showed symptomatic relief. In conclusion, it is our feeling that surgical intervention may not be necessary in definitive management of esophageal cancer on basis of this study although it is difficult to draw definite conclusion because this report is the retrospective study and the number of patients population is small.

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The Treatment Results of Combination of Radiotherapy and chemotherapy in Limited Stage Small Cell Lyug Cancer: Chang Ok Suh, Jun Kyu Loh, Kyung Ran Park, Chang Ok Suh, Gwi Eon Kim, Jae Kyung Roh, Seong Kyu Kim, Byung Soo Kim; J Korean Cancer Assoc. 1990;22(1):131-144.

Abstract PDF: A total of 72 patients with limited stage small cell lung cancer treated with combination of chemotherapy and radiotherapy at Department of Radiation Oncology, Yonsei University College of Meidcine between Jan. 1975 and Dec. 1986 were retrospectively analysed. 1) Age distribution of patients was between forty and seventy-one with median age fifty-five and male to female ratio was 5:l. 2) Complete response rate by treatment modality was as follows; CV+RT was 33.3%; CAV+RT, 43.59o, MOCA+RT. 28.6% and CAV+VP+RT was 62.5%. CAV+VP+RT group showed best result and this was statistically significant to MOCA+RT group (p=0.02) but insignificant to CV+ RT or CAV+RT grouP (P>0.1). 3) Median survival and 5 year actuarial survival rate by treatment modality were as follows; CVt RT was 15 3 months and 16.2%. CAV+RT, 14months and 16.396; MOCA+RT, 7month and 09; and CAV+ VP+ RT was 24 month and 30.7% respectively. CAV+VP+ RT groulp shawed the best results and these were statistically significant to MOCA+RT group(p<0.05) but insignificant to CV+RT or CAV+RT group (p>0,05). 4l Patterns of failure in complete response group were as follows; local failure was 24%, distant failure, 52% and local and distant failure was 24%. 5) Local control rate by radiation dosage in complete response group was as follows; when total dose of 4500-4900 cGv was given, local control rate was 50%; 5000 cGy, 43% however when total dose was given between 5100-7000 cGy, local control rate was significantly improved to 100%. 6) The incidences of brain metastsis in PCI (prophylactic cranial irradiation) group and control group were 20% and 32% respectively, although this was statistically insignificant (p=0.32). 7) Statistically significant factors affecting prognosis were performance status, TNM stage, initial status of presentation of superior vena cava syndrome and pleural effusion, location of tumor, response status to treatment and whether or not maintenance chemotherapy is added.

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Treatment results of Definitive Radiation Therapy in Esophagaeal Cancer: Kyung Ran Park, Jun Kyu Loh, Chung Sik Rhee; J Korean Cancer Assoc. 1990;22(1):162-171.

Abstract PDF: A total of 88 patients with epidermoid carcinoma of esophagus treated with definitive radiotherapy at Department of Radiation Oncology. Yonsei University College of Medicine between Jan. 1971 and Dec. 1986 were retrospectivelv analysed. 1) Age distribution of patients was between thirty two and eighty with median age of sixty four and male to female ratio was 12:l. 2) Distributions of esophageal carcinoma were 8% at cervical esophagus, 68. 2% at thoracic upper two third. 22.7% Bt thoracic lower one third and 1.1% at multiple site. 3) Response rates were complete response 26.5%, partial response 67.6% and no response 5.9% 4) Median survival was 12 months, Two year and 5 year actuarial survival rate were 23% and 7% respec ti vely. 5) Median survival and 4 year actuarial survival rate by treatment modality were as follows; radiation therapy alc!ne was 12 months and 12.6% and combined chemo-radiotherapy was 11 months and 7.8%. There was no difference in survival rate between two groups. 6) Patterns of treatment failure were locoregional failure 43.2%, distant failure 21.6% and both locoregional and distant failure 35.2%. 7) Statistically significant prognastic factors were tumar response to radiotherapy (P=0.000) and tumor location (P=0.043), while all others such as age, sex, tumor size, chernotherapy and radiation dose were not important.

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