Optimal radiation dose for patients with one to three lymph node positive breast cancer following breast-conserving surgery and anthracycline plus taxane-based chemotherapy: A retrospective multicenter analysis (KROG 1418)

BACKGROUND AND PURPOSE: This study was performed to determine optimal radiation dose in pN1 breast cancer patients who received breast conserving surgery (BCS) and anthracycline plus taxane (AT)-based chemotherapy. MATERIALS AND METHODS: Retrospective chart reviews were performed in 1,147 patients who were treated between January 2006 and December 2010. The impact of radiation dose on treatment outcomes was evaluated. RESULTS: Median follow-up time was 66 months. The 5-year rate of disease-free survival (DFS) was 93.2%. Larger tumor size (> 20 mm), positive lymphovascular invasion, high histologic grade, and high ratio of positive nodes (> 0.1) were significantly associated with inferior DFS. By using the 4 factors related to DFS, patients were categorized into high-risk (with ≥ 3 factors) and low-risk (with < 3 factors) groups. In the high-risk group, higher radiation dose (> 60.3 Gy(EQD2)) was significantly associated with better DFS than the lower dose (≤ 60.3 Gy(EQD2)). However, the radiation dose did not impact DFS in the low-risk group. CONCLUSIONS: Dosing of radiation affects the outcome of post-BCS radiotherapy in pN1 breast cancer. Doses of over 60.3 Gy(EQD2) were associated with better outcome in the high-risk patients.