Comparison of Breast Conserving Surgery Followed by Radiation Therapy with Mastectomy Alone for Pathologic N1 Breast Cancer Patients in the Era of Anthracycline Plus Taxane-Based Chemotherapy: A Multicenter Retrospective Study (KROG 1418)

Abstract

Purpose We compared the oncologic outcomes of breast-conserving surgery plus radiation therapy (BCS+RT) and modified radical mastectomy (MRM) under anthracycline plus taxane-based (AT) regimens and investigated the role of adjuvant radiation therapy (RT) in patients with pathologic N1 (pN1) breast cancer treated by mastectomy. Materials and Methods We retrospectively reviewed the medical records of 2,011 patients with pN1 breast cancer who underwent BCS+RT or MRM alone at 12 institutions between January 2006 and December 2010. Two-to-one propensity score matching was performed for balances in variables between the groups. Results The median follow-up duration for the total cohort was 69 months (range, 1 to 114 months). After propensity score matching, 1,074 patients (676 in the BCS+RT group and 398 in the MRM-alone group) were analyzed finally. The overall survival, disease-free survival, locoregional failure-free survival, and regional failure-free survival (RFFS) curves of the BCS+RT group vs. MRM-alone group were not significantly different. The subgroup analysis revealed that in the group with both lymphovascular invasion (LVI) and histologic grade (HG) III, the BCS+RT showed significantly superior RFFS (p=0.008). Lymphedema (p=0.007) and radiation pneumonitis (p=0.031) occurred more frequently in the BCS+RT group than in the MRM-alone group, significantly. Conclusion There are no differences in oncologic outcomes between BCS+RT and MRM-alone groups under the AT chemotherapy regimens for pN1 breast cancer. However, BCS+RT group showed superior RFFS to MRM-alone group in the patients with LVI and HG III. Adjuvant RT might be considerable for pN1 breast cancer patients with LVI and HG III.

Risk factors to identify the indication for regional nodal irradiation in T1-2N1M0 breast cancer: A joint analysis of 4,243 real-world cases from two institutions

“…The value of RNI in patients with T1-2N1M0 breast cancer remains a topic of great clinical relevance and controversy. Our results showed that the 5-year LRR was 7.2% in patients with T1-2N1M0 breast cancer without RNI, which is consistent with other contemporary studies showing that the 5-year LRR was less than 10% ( 9 , 17 – 19 ). Given the low LRR risk, the necessity of RNI in T1-2N1M0 breast cancer has been questioned.…”

Chemo-treated 4T1 breast cancer cells radiation response measured by single and multiple cell ionization using infrared laser trap

“…Although breast cancer ranks second, behind lung cancer, in the number of new cancer cases (12%), it has a relatively low death rate (7%), ranking fifth next to liver cancer. This higher survival rate might be credited to the advancement of traditional therapies such as radiotherapy 3,4 chemotherapy 5–8 , surgery 9 and to the development of relatively newer therapies such as hypothermia and hyperthermia that uses nanotechnology 10–13 and immunotherapy 14 .…”

Neoadjuvant systemic therapy does not compromise local control after breast-conserving surgery: a single-center, propensity score matching study in China

“…Given this situation, we applied propensity score matching to balance the clinical T-stage and N-stage. Propensity score matching was used recently to compare BCS and mastectomy in several retrospective studies ( 23 , 24 ). After propensity score matching, clinical T-stage (P=0.144) and clinical N-stage (P=0.744) were no longer significantly different between the two groups ( Table 2 ).…”