ARE AXILLARY RECURRENCE AND OVERALL SURVIVAL AFFECTED BY AXILLARY EXTRANODAL TUMOR EXTENSION IN BREAST-CANCER - IMPLICATIONS FOR RADIATION-THERAPY

Purpose: To determine the overall survival and local recurrence signif icance of axillary lymph node extranodal rumor extension (ETE) and whe ther axillary/chest-wall irradiation influenced any of these outcomes. Materials and Methods: The records of 81 breast cancer patients treat ed with radical or modified radical mastectomy at a single surgical pr actice were eligible for study. Thirty-four patients had ETE: 17 with focal ETE (< 10 x high-power field) and 17 with extensive ETE (> 10 x high-power field). Results: With a median follow-up duration of 92 mon ths, only two patients had on axillary recurrence (2%): one had focal ETE and one hod no ETE. Neither of these patients received axillary ra diation therapy. Overall survival and recurrence-free survival were si gnificantly decreased with ETE in patients whether axillary radiation therapy had been administered or not. Analysis showed that the age of the patient correlated significantly with extensive ETE (P = .04) and that the number of positive lymph nodes (less than or equal to three v > three) correlated significantly with ETE (whether focal or extensiv e) (P = .0001). A multivariate analysis of extranodal tumor extension and number of positive lymph nodes showed that ETE was associated with decreased survival (P = .05), although to a lesser degree than number of positive lymph nodes (P = .003). Conclusion: These results show th at ETE is associated with decreased survival and increased recurrence rotes regardless of the extent of the radiation therapy field. Also, E TE does not necessarily indicate a significantly increased incidence o f axillary recurrence. Therefore, axillary irradiation based on this p athologic finding may not be indicated.