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Home > Understanding Breast Cancer > Breast Cancer Research > Table 38: Radiation therapy following mastectomy and overall survival in stage II & III breast cancer

  


Table 38: Radiation therapy following mastectomy and overall survival in stage II & III breast cancer

This summary table contains detailed information about research studies. Summary tables offer an informative look at the science behind many breast cancer guidelines and recommendations. However, they should be viewed with some caution. In order to read and interpret research tables successfully, it is important to understand some key concepts. Learn how to read a research table.

Introduction: Radiation therapy is not often used after mastectomy for women with stage I or II breast cancer. However, it is recommended for women with four or more positive lymph nodes to improve survival [1]. Radiation therapy should also be considered for women with [1]:

  • One to three positive lymph nodes
  • Negative lymph nodes, but a tumor larger than five centimeters
  • Negative lymph nodes, but positive tumor margins  
  • Negative lymph nodes and tumor is five centimeters or smaller, but tumors margins are close

Radiation therapy after mastectomy and survival

The results of two large randomized clinical trials with more than 10 years of follow-up suggest women with lymph node-positive (stage II or III) breast cancer benefit from radiation therapy after mastectomy [2-3].

Radiation therapy after mastectomy lowers the risk of breast cancer recurrence. Studies show it also improves overall survival in women at high risk of recurrence. A study that combined the results of 78 randomized treatment comparisons found that radiation therapy lowered the risk of dying from breast cancer or any cause 15 years after treatment [4].

Radiation therapy and health risks 

Older studies of radiation therapy show an increase in deaths from breast cancer in the opposite breast, heart disease and lung cancer [4]. Modern radiation therapy is given in lower doses than in the past and thus, these health risks appear to be much lower [5]. For example, studies of modern radiation therapy after breast surgery show no increased risk of breast cancer in the opposite breast [6-8].

Learn about the strengths and weaknesses of different types of studies.

Study selection criteria: Randomized clinical trials with at least 1,000 participants and 10 or more years of follow-up and meta-analyses.

Study 

Study Population
(number of participants)
 

Stage of
Br
east Cancer 

Follow-up
(years) 

Number of
Positive Nodes
 

Overall Survival 

Percent Surviving— 

Radiation Therapy after
Mastectomy
 

Percent Surviving— 

No Radiation Therapy after
Mastectomy
 

Randomized clinical trials 

DBCG 82b Trial [2]

1,708 premenopausal women

Stage II & III

10

1-3

62%

54%

       

4 or more

32%

20%

DBCG 82c Trial [3]

1,375 postmenopausal women

Stage II & III

10

1-3

55%

44%

       

4 or more

24%

17%

Meta-analyses 

EBCTC [4]

8,505

Stage II & III

15

1 or more

40%

36%

 

1,890

Stage II & III

15

1-3

49%

47%

 

1,868

Stage II & III

15

4 or more

29%

28%

Gebski et al. [9]

6,946* 

Stages I-III

10

1 or more

53%

47% 

* Only included studies that used optimal radiation dosage and coverage 
† Calculated from data in study  

References  

1. National Comprehensive Cancer Network. NCCN Clinical practice guidelines in oncology: Breast cancer, version 3.2013. http://www.nccn.org, 2013.

2. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med. 337:949-55, 1997.

3. Overgaard M, Jensen MB, Overgaard J, et al. Postoperative radiotherapy in high-risk postmenopausal breast cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet. 353:1641-8, 1999.

4. Clarke M, Collins R, Darby S, et al. for the Early Breast Cancer Trialists' Collaborative Group. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 366(9503):2087-106, 2005.

5. Early Breast Cancer Trialists' Collaborative Group. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet. 355:1757-70, 2000.

6. Neilson HM, Overgaard M, Grau C, et al. Study of failure pattern among high-risk breast cancer patients with or without postmastectomy radiotherapy in addition to adjuvant systemic therapy: long-term results from the Danish Breast Cancer Cooperative Group DBCG 82 b and c randomized studies. J Clin Oncol. 24(15):2268-75, 2006.

7. Kirova YM, Gambotti L, De Rycke Y, Vilcoq JR, Asselain B, Fourquet A. Risk of second malignancies after adjuvant radiotherapy for breast cancer: a large-scale, single-institution review. Int J Radiat Oncol Biol Phys. 68(2):359-63, 2007.

8. Berrington de Gonzalez A, Curtis RE, Gilbert E, et al. Second solid cancers after radiotherapy for breast cancer in SEER cancer registries. Br J Cancer. 102(1):220-6, 2010.

9. Gebski V, Lagleva M, Keech A, et al. Survival effects of postmastectomy adjuvant radiation therapy using biologically equivalent doses: a clinical perspective. J Natl Cancer Inst. 98(1):26-38, 2006.

Updated 01/13/14