Do surgical oncologists achieve lower rates of local-regional recurrence in node positive breast cancer treated with mastectomy alone?

Background and Objective: Adjuvant radiotherapy for node positive breast ca ncer postmastectomy has been recommended by two previously published random ized controlled trials (RCT). The local-regional recurrence rates in the co ntrol arms., however, were considered by some critics to be excessive (> 25 % at 10 years). Inadequate surgery, as evidenced by the low number of axill ary nodes reported, may have resulted in the high local-regional recurrence rates, allowing for the benefits seen with radiotherapy. Fellowship traine d surgical oncologists might provide "better quality" surgery, resulting in lower recurrence rates and thus making adjuvant radiotherapy unnecessary. Our objective was to establish the local-regional control rate postmastecto my in node positive breast cancer patients operated on by surgical oncologi sts, and to determine if treatment recommendations from previous RCTs are g eneralizable. Methods: Node positive stage IIb and IIIa breast cancer patients treated wi th mastectomy at the Medical College of Virginia Hospitals by surgical onco logists, without adjuvant radiotherapy, and entered into adjuvant chemother apy trials between 1978 and 1993 were identified retrospectively. Pathology and follow-up records were reviewed. Results: One hundred and thirty-seven patients were identified. A median of 18 axillary nodes was reported with a median of 4 positive nodes. The loco regional recurrence at 10-years was 27% (95% confidence interval, 19-35%). Conclusion: Despite some evidence of "better quality" surgery, there was no clinically significant difference in the local-regional recurrence rate in this case series compared to controls in two previous RCTs. Recommendation s for postmastectomy radiotherapy should be considered for node positive br east cancers, even if operated upon by surgical oncologists. (C) 2001 Wiley -Liss, Inc.