Das Risiko des Lokalrezidivs nach Mastektomie beim Mammakarzinom in Abhängigkeit der postoperativen Thoraxwandbestrahlung

Objective: Chest wall irradiation after mastectomy for breast cancer is now usually reserved for patients with extensive carcinomatous lymphangiosis or positive surgical margins. However, recent studies suggest that the reduced risk for local recurrence following radiotherapy of the chest wall might improve the survival of these patients. We studied the influence of chest wall irradiation on local recurrence and overall survival rates in patients with breast cancer treated with mastectomy. Methods: We reviewed 1964 patients with pT 1-2 breast cancer treated with mastectomy since 1963. Patients treated before 1979 routinely received chest wall irradiation while those treated after 1979 received irradiation only if there was histologic evidence of extensive carcinomatous lymphangiosis or positive surgical margins. The groups were compared with Kaplan-Meier analysis and the log-rank test. Results: Patients, who received adjuvant radiotherapy had a significantly lower rate of local recurrence regardless of the nodal status. Ten years after primary diagnosis, 98% of patients who received irradiation are free of local recurrence, compared with 86% of those who did not (p <0.001). In patients with negative nodes, there was no difference in survival between patients who received irradiation and those who did not. In patients with positive nodes, patients who received irradiation had poorer overall survival than those who did not, probably due to more advanced disease. Conclusions: These data indicate that adjuvant radiotherapy after mastectomy for breast cancer decreases the rate of local recurrence but without improving overall survival.