Clinical outcomes of post-operative locoregional radiotherapy in premenopausal and post-menopausal Chinese women with breast cancer

Background and purposes: Recent randomized studies from the West show that post-operative locoregional radiotherapy improves survival in lymph node (L N) positive pre-menopausal women with breast cancer but this benefit has no t been established in the Chinese population. There is no published study o n clinical outcomes (locoregional recurrence, survival and toxicities) of p ost-operative locoregional radiotherapy in Chinese women with breast cancer . Materials and methods: We conducted a retrospective study of 399 female Chi nese patients with breast cancer who had received postmastectomy locoregion al radiotherapy in our center between 1984 and 1990. The patients were stra tified according to tumor size, menopausal and LN status. We analyzed the i ncidence and pattern of locoregional recurrence, distant recurrence, surviv al rates and toxicity related to radiotherapy. Results: Of the 399 patients 216 were pre-menopausal and 183 were post-meno pausal. The mean age was 49.3 years (23-83). Distribution of tumor size and LN status of the two groups was similar. Median follow-up was 71.9 months. Locoregional recurrence occurred in 57 (14.3%) patients (pre-menopausal 24 (11.1%); post-menopausal 33 (18.3%) P = 0.489). Recurrence was more common in LN positive patients (18.2%) than LN negative patients (9.2%). The patt ern of locoregional recurrence was: chest wall 24, axilla LN 12, supraclavi cular LN 10, chest plus LN 11. The distant recurrence rate was 39.6% for al l patients and 75.4% for patients with locoregional recurrences. The overal l 10-year survival rate for all patients was 54%. For LN positive patients the 10-year survival rate of pre-menopausal and postmenopausal women was 38 and 51%, respectively (P = 0.207), and for LN negative patients the rate w as 73 and 70%, respectively (P = 0.603). Acute skin toxicity included redne ss (30.8%), dry desquamation (12.8%), and wet desquamation (6.8%). Long-ter m toxicities included skin atrophyl (0.3%), telangectasia (3.3%), pneumonit is (2.8%) and brachial plexus palsy (1.3%). Conclusions: In our series Chinese patients with node-positive breast cance r have a relatively high locoregional recurrence rate in spite of mastectom y and post-operative radiotherapy. Limited use of adjuvant system chemother apy may account, at least in part, for this finding. Clinical outcomes of p ost-operative radiotherapy in pre-menopausal and post-menopausal breast can cer patients are similar. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.