BALTIMORE--Irradiation of the chest wall following mastectomy
has had an up and down history as breast cancer therapy. Now,
says Allen S. Lichter, MD, director of Radiation Oncology, University
of Michigan Medical Center, it is time to take another look at
its value for patients with local or regional disease after surgery.
About one third of all first failures are on the chest wall, Dr.
Lichter said, and the rate is even higher for node-positive patients.
"I think we need to take this off the shelf again and start
to use it," he said, urging new randomized trials.
In his presentation at a conference on neoplastic disorders, sponsored
by Johns Hopkins Oncology Center, Dr. Lichter, cited studies during
the last 40 years showing that chest wall irradiation significantly
reduces the number of chest wall failures and increases disease-free
survival. However, the procedure appears not to improve overall
survival and may actually decrease it, due to an excess rate of
These ambiguous results, he said, are due both to the nature of
the disease and the design of the trials.
In retrospect, Dr. Lichter said, studies beginning with the Manchester
Trial (1949-1955) were clouded by uneven radiotherapy techniques,
mixed groupings of patients (node positive and negative, premenopausal
and postmenopausal), hormonal therapy in some cases, and small
Regarding the disease itself, Dr. Lichter would divide patients
into three groups: those with local disease that is cured by mastectomy;
those with occult disseminated disease at presentation; and those
with some residual local-regional disease after mastectomy, but
It is this last group (perhaps 10% of the total) that could be
helped by postmastectomy radiation therapy, Dr. Lichter believes,
even given recent advances in systemic therapy.