De-escalation of radiotherapy after primary chemotherapy in cT1–2N1 breast cancer (RAPCHEM; BOOG 2010–03): 5-year follow-up results of a Dutch, prospective, registry study

Wild, Sabine R de; Munck, Linda de; Simons, Janine M.; Verloop, Janneke; Dalen, Thijs van; Elkhuizen, Paula H.M.; Houben, Ruud; Leeuwen, A. Elise van; Linn, Sabine C.; Pijnappel, Ruud M; Poortmans, Philip; Strobbe, Luc J. A.; Wesseling, Jelle; Voogd, Adri C.; Boersma, Liesbeth

doi:10.1016/s1470-2045(22)00482-x

Cited by 48 publications

(41 citation statements)

References 29 publications

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“…Finally, the lower access of women with SMI to the most intensive combination of cancer treatment could be explained by clinical factors which were not measurable in our research, such as grading, hormonal receptor status (but we matched cases and controls on age that strongly drives this status), biomarkers, or histological subtypes which are important for some treatment choices [ 66 ]. It should also be noted that new research findings are constantly emerging on the right intensity of treatment for each type of breast cancer [ 67 , 68 ]. In addition, the most significant differences in indicators of the quality of cancer care pathways between women with and without SMI were found for indicators linked to diagnosis and follow-up rather than treatment itself.…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer Care Pathways for Women with Preexisting Severe Mental Disorders: Evidence of Disparities in France?

Seppänen

Daniel

Houzard

et al. 2023

JCM

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The excess cancer mortality in persons with severe mental illness (SMI) has been well documented, and research suggests that it may be influenced by care-related factors. Our objective was to assess breast cancer care pathways in women with SMI in France, using an exhaustive population-based data-linkage study with a matched case-control design. The cases were 1346 women with incident breast cancer in 2013/2014 and preexisting SMI who were matched with three controls without SMI presenting similar demographics, initial breast cancer type, and year of incidence. We compared cancer care pathways and their quality for cases and controls, using a consensual set of indicators covering diagnosis, treatment, follow-up, and mortality (until 2017). After adjusting for covariates, cases had lower odds to undergo the main diagnostic tests, lumpectomy, adjuvant chemotherapy, and radiotherapy, as well as hormone therapy, but higher odds for mastectomy. Suboptimal quality in cancer pathways was observed for both groups, but to a higher extent for cases, especially for not receiving timely care after diagnosis and post-treatment follow-up. Breast cancer mortality, considering competing risks of deaths, was significantly elevated in women with SMI. These findings highlight disparities in cancer care pathways for individuals with SMI, as well as specific aspects of the care continuum which could benefit from targeted actions to reach equity of outcomes.

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Section: Discussionmentioning

confidence: 99%

Breast Cancer Care Pathways for Women with Preexisting Severe Mental Disorders: Evidence of Disparities in France?

Seppänen

Daniel

Houzard

et al. 2023

JCM

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“…The results from prospective trials are needed to firmly establish an appropriate system for locoregional treatment decisions. The RAPCHEM BOOG 2010–03 trial is designed to clarify the role of PMRT in cT1–2N1 patients according to ypN status [ 16 ]. In the low-risk group, which consisted of ypN0 patients, radiotherapy did not result in significantly altered 5-year LRR.…”

Section: Discussionmentioning

confidence: 99%

The impact of postmastectomy radiotherapy on cT1-2N1 breast cancer patients with ypN0 after neoadjuvant chemotherapy: a retrospective study based on real-world data

Dai

Lan

et al. 2023

Discov Onc

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Background The role of postmastectomy radiation therapy (PMRT) in clinical T1-2N1 breast cancer patients who achieve axillary pathological complete response (ypN0) after neoadjuvant chemotherapy (NAC) is controversial. Methods Data from cT1-2N1 breast cancer patients who converted to ypN0 after NAC and subsequent surgery were retrospectively analyzed. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan‒Meier method. Univariate and multivariate Cox regression models were applied to investigate the correlations between clinical or pathological parameters and survival. Results From 2012–2019, we identified 116 cases for analysis, including 31 (26.7%) who received PMRT and 85 (73.3%) who did not. At a median follow-up time of 56.4 months, the 5-year DFS and OS rates were 90.2% and 96.7% with PMRT and 93.7% and 97.3% without PMRT, respectively. PMRT did not affect either DFS (p = 0.234) or OS (p = 0.878). On multivariate analyses, no differences in DFS or OS between the two groups were detected, taking into consideration the following factors: age, molecular subtype, Ki67 index, cT stage, and in-breast pathologic complete response (DFS: HR 2.260; 95% CI 0.465–10.982; p = 0.312. OS: HR 1.400; 95% CI 0.138–14.202; p = 0.776). This nonsignificant difference was also consistent in subgroup analyses (all p > 0.05). Conclusions PMRT has limited ability to confer DFS or OS benefits for cT1-2N1 breast cancer patients who achieved axillary pathological complete response after NAC and total mastectomy. It is imperative to conduct prospective studies to investigate the safety and feasibility of omitting PMRT. Trial registration: This research was approved by the Ethics Committee of The First Affiliated Hospital of Chongqing Medical University (ID: No. 2021–442).

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“…They found that locoregional RT did lower the 5-yr LRR rate in patients with ypN + disease, but not in patients with ypN0 disease. Recently, De Wild et al [ 43 ] presented the data of the RAPCHEM study; in this prospective cohort study, locoregional RT was de-escalated according to predefined study guidelines based on the ypN status in patients with cT1-2N1 disease, with ≤3 suspicious nodes at imaging. Six hundred eighty-one of the included 838 patients underwent ALND.…”

Section: De-escalation Of Regional Nodal Radiotherapy After Pst and Alndmentioning

confidence: 99%

Regional radiotherapy after primary systemic treatment for cN+ breast cancer patients

Boersma¹,

Mjaaland²,

Duijnhoven³

2023

The Breast

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De-escalation of radiotherapy after primary chemotherapy in cT1–2N1 breast cancer (RAPCHEM; BOOG 2010–03): 5-year follow-up results of a Dutch, prospective, registry study

Cited by 48 publications

References 29 publications

Breast Cancer Care Pathways for Women with Preexisting Severe Mental Disorders: Evidence of Disparities in France?

Breast Cancer Care Pathways for Women with Preexisting Severe Mental Disorders: Evidence of Disparities in France?

The impact of postmastectomy radiotherapy on cT1-2N1 breast cancer patients with ypN0 after neoadjuvant chemotherapy: a retrospective study based on real-world data

Regional radiotherapy after primary systemic treatment for cN+ breast cancer patients

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