Journal of Clinical Oncology, Vol 13, 2869-2878, Copyright © 1995 by American Society of Clinical Oncology
Adequate locoregional treatment for early breast cancer may prevent secondary dissemination
R Arriagada, LE Rutqvist, A Mattsson, A Kramar and S Rotstein
Institut Gustave-Roussy, Villejuif, France.
PURPOSE: To analyze different events that determine event-free survival
(EFS) in a randomized trial on adjuvant radiotherapy in early breast cancer
patients with more than 15 years of follow-up evaluation. PATIENTS AND
METHODS: The trial included 960 patients with a unilateral, operable breast
cancer. Surgery consisted of a modified radical mastectomy. The trial
compared three arms, as follows: preoperative radiotherapy, postoperative
radiotherapy, and no adjuvant treatment. Events were analyzed by a
competing-risk approach. A proportional hazards multiple regression model
was used to analyze the effects of radiotherapy on the risk of distant
metastasis. Similar analyses were performed separately for node-negative
[N(-)] and node- positive [N(+)] patients in the two groups that did not
include preoperative radiotherapy. RESULTS: Radiotherapy produced a
fivefold decrease of the risk of local recurrence (P < .0001). In N(+)
patients, postoperative radiotherapy decreased the risk of distant
dissemination (relative risk, 0.63). When local recurrence was introduced
in the model as a time-dependent covariate, this factor was predictive of
distant dissemination (P < .0001) and nullified the effect of
postoperative radiotherapy. This finding suggests that the decrease of
distant metastases was related to the prevention of local recurrence. A
similar effect was found in models that used overall survival as an end
point. CONCLUSION: This study shows that postmastectomy radiotherapy in
N(+) breast cancer patients may decrease the distant metastasis rate by
preventing local recurrences and thus avoiding secondary dissemination.
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