We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

“Unnecessary” Postmastectomy Radiation Therapy—Reply

J. David Beatty, MD
Arch Surg. 2011;146(6):765. doi:10.1001/archsurg.2011.132.
Text Size: A A A
Published online


In reply

I would like to thank the Archives of Surgery for the opportunity to reply to the thought-provoking comments of Dr Evans. Like Dr Evans, I would challenge the assumption that the American Society of Clinical Oncology guidelines for breast cancer formulated in 2001 are the best guidelines for postmastectomy irradiation, but they are widely used by our radiation oncology colleagues in formulating treatment recommendations. I am also pleased to know that Dr Evans feels that T3N0 (>5 cm in primary tumor size) in isolation is no longer appropriate for postmastectomy irradiation. I applaud her statement that “[t]he dictum that either a tumor size greater than 5 cm or the presence of 4 or more positive nodes is an indication for postmastectomy radiation therapy is no longer valid.” As noted in my discussion1 of the paper by Christante et al,2 a careful review of the recurrence rates of T3N0 breast cancer in patients treated in our institution over the past 20 years fails to identify a benefit for postmastectomy irradiation in this group at a low risk of recurrence without radiation therapy. A manuscript detailing these results has been presented at the Annual Meeting of the North Pacific Surgical Association (November 12-13, 2010; Tacoma, Washington) and has been accepted for publication.3 In this study,3 we showed significant decreases in local, local-regional, and distant recurrence rates and a significant increase in the recurrence-free survival rate in patients at a high risk of recurrence (T1N2 or T1N3 stage, T2N2 or T2N3 stage, and T3N1, T3N2, or T3N3 stage) with postmastectomy irradiation. Unfortunately, the massive meta-analysis study4 referred to by Dr Evans that evaluated 78 prospective trials and 42 000 patients with breast cancer did not do a subgroup analysis combining T and N stage. This leaves the study open to the T3N0 type of error and undermines the study's credibility.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





June 1, 2011
Suzanne B. Evans, MD, MPH
Arch Surg. 2011;146(6):764-765. doi:10.1001/archsurg.2011.131.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles