Adjuvant locoregional radiation therapy in breast cancer patients with pathologic complete response after neoadjuvant chemotherapy: A systematic review and meta-analysis

Nikyar, Normehr; Tegnelius, Eva; Valachis, Antonis

doi:10.1016/j.ctro.2021.12.010

Cited by 8 publications

(6 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Additionally, NAT has been widely accepted to reduce the tumor burden in patients with positive FNAC results. Even in postoperative breast cancer patients with initially positive ALNs and ypN0 disease after NAT, adjuvant locoregional radiation therapy has been shown to reduce the risk of locoregional recurrence 13 . Therefore, the accuracy of FNAC is essential for clinical treatment.…”

Section: Discussionmentioning

confidence: 99%

Utility of GATA‐3 immunocytochemistry for the assessment of fine‐needle aspiration in breast cancer patients with suspicious axillary lymph nodes at ultrasound

Lan,

Zhang,

et al. 2023

Diagnostic Cytopathology

View full text Add to dashboard Cite

BackgroundUltrasound‐guided fine‐needle aspiration cytology (FNAC) is a routine preoperative method for evaluating suspicious axillary lymph nodes (ALNs) in patients with breast cancer. However, a range of reasons such as morphological pitfalls, technical artifacts, and sampling errors restrict the sensitivity and accuracy of FNAC. This retrospective study investigated the diagnostic value of GATA‐binding protein 3 (GATA‐3) immunocytochemistry for FNAC.MethodsBreast cancer patients who underwent preoperative FNAC for suspicious ALNs, relevant GATA‐3 immunocytochemistry, and postoperative status of ALNs were reviewed from the period of March 2020 to February 2022. Altogether, 102 patients were included in the study. FNAC material smears stained with hematoxylin and eosin was initially assessed by two cytopathologists and categorized into five groups: nondiagnostic, negative, atypical, suspicious, and positive for malignancy. Only group of cells positive for malignancy was considered positive. For each case, two selected slides were digitized (whole slide imaged) at ×40 magnification and decolored for GATA‐3 immunocytochemistry. The expression of GATA‐3 was scored ranging from 0 to 9 (Score ≥3: Positive, Score ≤2: Negative). If either FNAC or GATA‐3 immunocytochemistry was positive or the combined test positive, then the case was considered positive. The sensitivity, specificity, and accuracy of FNAC, GATA‐3 immunocytochemistry, and combined FNAC/GATA‐3 immunocytochemistry were analyzed by χ2 and Fisher's tests.ResultsThe mean age of the study participants was 50.62 (ranging: 30–73 years). Invasive breast carcinoma (not otherwise specified) accounted for most histological subtypes, and grade 2 was the leading Nottingham grade. Sixteen cases directly underwent mastectomy while the other 86 patients had neoadjuvant therapy. A more serious diagnosis was made based on GATA‐3 detection in 22.5% (n = 23) of 102 cases. Of the 23 cases, metastasis was confirmed by GATA‐3 detection in 21 cases, and an uncertain diagnosis was ascertained based on GATA‐3 immunocytochemistry in 2 with nondiagnostic FNAC results. The sensitivity (77/87, 88.5%) of GATA‐3 detection for distinguishing malignancies from benign lesions was higher than that of FNAC alone (62/87, 71.3%) (p < .05).ConclusionsGATA‐3 immunocytochemistry exhibited high diagnostic efficacy in distinguishing malignant breast cancer cells. Moreover, combined FNAC and GATA‐3 immunocytochemistry achieved optimal results in terms of reducing the false‐negative rate and promoting accuracy.

show abstract

Section: Discussionmentioning

confidence: 99%

Utility of GATA‐3 immunocytochemistry for the assessment of fine‐needle aspiration in breast cancer patients with suspicious axillary lymph nodes at ultrasound

Lan,

Zhang,

et al. 2023

Diagnostic Cytopathology

View full text Add to dashboard Cite

show abstract

“…A meta-analysis investigating the benefit of adjuvant locoregional radiotherapy in patients with clinically positive lymph nodes and pathological complete response treated with mastectomy or breast-conserving surgery demonstrated the benefit of locoregional radiotherapy in lowering locoregional recurrence rate, but no effect on disease-free- or overall survival. However, in clinical practice, the results of this meta-analysis should be interpreted with caution because of the low level of evidence [ 24 ].…”

Section: Radiotherapy After Neoadjuvant Chemotherapymentioning

confidence: 99%

The Role of Adjuvant Radiotherapy in the Treatment of Breast Cancer

Kolářová,

Melichar,

Sirák

et al. 2024

Current Oncology

View full text Add to dashboard Cite

The role of postmastectomy radiotherapy and regional nodal irradiation after radical mastectomy is defined in high-risk patients with locally advanced tumors, positive margins, and unfavorable biology. The benefit of postmastectomy radiotherapy in intermediate-risk patients (T3N0 tumors) remains a matter of controversy. It has been demonstrated that radiotherapy after breast-conserving surgery lowers the locoregional recurrence rate compared with surgery alone and improves the overall survival rate. In patients with four or more positive lymph nodes or extracapsular extension, regional lymph node irradiation is indicated regardless of the surgery type (breast-conserving surgery or mastectomy). Despite the consensus that patients with more than three positive lymph nodes should be treated with radiotherapy, there is controversy regarding the recommendations for patients with one to three involved lymph nodes. In patients with N0 disease with negative findings on axillary surgery, there is a trend to administer regional lymph node irradiation in patients with a high risk of recurrence. In patients treated with neoadjuvant systemic therapy and mastectomy, adjuvant radiotherapy should be administered in cases of clinical stage III and/or ≥ypN1. In patients treated with neoadjuvant systemic therapy and breast-conserving surgery, postoperative radiotherapy is indicated irrespective of pathological response.

show abstract

“…Было выявлено преимущество ЛТ для безрецидивной выживаемости. Фактически это продолжающееся рандомизированное исследование NSABP B-51/ RTOG 1304 [5].…”

Section: влияние лучевой терапии на рецидив рака молочной железыunclassified

Radiation Therapy for Breast Cancer pT1–3N0–1M0 after Mastectomy or Subcutaneous/Skin-Preserving Mastectomy with Reconstruction. Literature Review

Рассказова¹,

Zikiryakhodzhaev²,

Khmelevsky³

2023

MEDICAL RADIOLOGY AND RADIATION SAFETY

View full text Add to dashboard Cite

Purpose: The literature review analyzes publications over the past decades on the need for radiation therapy after mastectomy or subcutaneous/skin-preserving mastectomy with reconstruction. Results: Risk factors for breast cancer recurrence were analyzed. The effect of radiation therapy on the recurrence of breast cancer after mastectomy, subcutaneous and skin-preserving mastectomy with reconstruction was evaluated depending on the stage, lymph node lesions, and the presence of unfavorable molecular biological types. Indications for radiation therapy are described. The effect of radiation therapy on early and late complications of the reconstructed breast and options for reducing the percentage of complications were analyzed. Conclusion: The exclusion of radiation therapy from the breast cancer treatment plan is a decrease in the percentage of complications caused by radiation therapy, for example, during implant reconstruction – a decrease in capsular contractures. And, as a result, improving the quality of life of patients, reducing repeated operations in case of complications, which means it is economically profitable. In recent years, due to the increasing need for various breast reconstruction options, the surgeon and radiotherapist have faced the task of choosing the optimal sequence of breast reconstruction, as well as reducing the risk of post-radiation complications. Radiation therapy, along with reducing the risk of relapse of the disease, increases the risk of complications after breast reconstruction, and vice versa, the reconstructed mammary gland can cause difficulties for the radiologist to correctly deliver the required dose of radiation. Minimizing the frequency and severity of complications after radiation therapy on the reconstructed gland without compromising oncological or cosmetic results is an important and common interdisciplinary goal for oncologists and radiotherapists.

show abstract

Adjuvant locoregional radiation therapy in breast cancer patients with pathologic complete response after neoadjuvant chemotherapy: A systematic review and meta-analysis

Cited by 8 publications

References 29 publications

Utility of GATA‐3 immunocytochemistry for the assessment of fine‐needle aspiration in breast cancer patients with suspicious axillary lymph nodes at ultrasound

Utility of GATA‐3 immunocytochemistry for the assessment of fine‐needle aspiration in breast cancer patients with suspicious axillary lymph nodes at ultrasound

The Role of Adjuvant Radiotherapy in the Treatment of Breast Cancer

Radiation Therapy for Breast Cancer pT1–3N0–1M0 after Mastectomy or Subcutaneous/Skin-Preserving Mastectomy with Reconstruction. Literature Review

Contact Info

Product

Resources

About