Loco-regional recurrence in 2064 patients with breast cancer treated with mastectomy without adjuvant radiotherapy L. Livi a, * , C. Saieva b , B. Detti a , I. Meattini a , T. Susini c , F. Paiar a , A. Mileo a , A. Rampini a , A. Bruni a , A. Petrucci a , G.P. Biti a a Department of RadiotherapyeOncology, Viale Morgagni no. 85, Florence University, 50134 Florence, Italy b Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Centre (CSPO), Scientific Institute of Tuscany, Florence, Italy c Gynaecology Unit, University of Florence, Italy Accepted 31 January 2007 Available online 26 March 2007 Abstract Introduction: We investigated the incidence of loco-regional recurrence in a sub-group of patients who underwent mastectomy without adjuvant radiotherapy to evaluate the effect of each specific clinical or pathological parameter that could be associated with a higher local relapse rate. Patients and methods: Two thousand and sixty-four patients were treated from January 1971 to December 2003 at the University of Florence. Results: At the time of analysis 18.3% of patients (378/2064) had isolated loco-regional failures. Univariate analysis showed an association of borderline statistical significance with pathological tumour size. Elderly age at diagnosis had a low incidence of local recurrence but the results did not reach statistical significant. The number of positive axillary lymph node did not show any influence for local recurrence. Conclusion: In our series we noted a higher relapse rate only related to the pathological tumour size without any correlation with number of positive axillary nodes. Radiotherapy after mastectomy still remains controversial, but in our series the number of positive axillary lymph node did not seem enough to justify adjuvant treatment. Ó 2007 Elsevier Ltd. All rights reserved. Keywords: Radiotherapy; Mastectomy; Local recurrence Introduction During the last 50 years, the efficacy of postoperative loco-regional irradiation to the chest wall and regional lymph nodes in women who undergo surgery for breast can- cer has been examined. 1e4 Results demonstrate a reduction in loco-regional recurrence. Hence, despite years of clinical study, there still remain many unanswered questions regard- ing post-mastectomy irradiation. 5 Moreover, there is no accepted standard of care concerning the use of radiation for patients treated with mastectomy and systemic therapy. Some would strongly advocate that such patients should re- ceive radiotherapy, but others would argue that the risk of loco-regional recurrence for such patients is low and that the potential risk of toxicities and the costs associated with post-mastectomy radiation in these patients may not be justified. 6,7 We retrospectively analysed 2064 patients with breast cancer treated only with mastectomy at the University of Florence to evaluate the effect of each specific clinical or pathological parameter that could be associated with a higher local relapse rate. We investigated the incidence of loco-regional recurrence with respect to tumour size, axillary lymph nodes status, pathological characteristics and adjuvant systemic treatment. Patients and methods Two thousand and sixty-four patients with invasive breast carcinoma were treated consecutively from January 1971 to December 2003 at the University of Florence. * Corresponding author. Tel.: þ39 055 7947719; fax: þ39 055 4379930. E-mail address: l.livi@dfc.unifi.it (L. Livi). 0748-7983/$ - see front matter Ó 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejso.2007.01.034 EJSO 33 (2007) 977e981 www.ejso.com