Impact of time to initiation of postoperative radiotherapy after neoadjuvant chemotherapy on the prognosis of breast cancer: A retrospective cohort study in China

Xie, Yuxin; Zhang, Yingjie; Xie, Keqi; Zheng, Hong

doi:10.1002/ijc.34003

Cited by 4 publications

(7 citation statements)

References 28 publications

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“…In our study population, the majority of patients started RT within 12 weeks after the last cycle of adjuvant chemotherapy or within 16 weeks after surgery when no adjuvant chemotherapy is given, which is consistent with previous reports (21)(22)(23). In a recent retrospective study of the impact of TTR on survival, among 95 patients treated with NAC without adjuvant chemotherapy, Xie et al (21) reported that 25 (26.3%), 54 (56.8%), and 16 (16.8%) started RT at <8 weeks, 8-16 weeks, and > 16 weeks from surgery, respectively. Compared with early BC patients treated with breast conservation with no indication of adjuvant chemotherapy, TTR is, in general, longer and more heterogenous in the NAT population.…”

Section: Discussionsupporting

confidence: 92%

“…Our study is not the first one that reports the negative relationship between short TTR and survival outcomes. Xie et al (21) found that TTRs of <8 weeks or >16 weeks were associated with increased risks of BC specific mortality and all-cause mortality compared with the TTR of 8-16 weeks. In another study of patients treated with BCS, TTR >55 days was associated with a higher 10-year DFS (HR = 0.60, 95% CI: 0.38-0.94) and DMFS (HR = 0.64, 95% CI: 0.45-0.92) than TTR < 42 days (26).…”

Section: Discussionmentioning

confidence: 99%

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Influence of Adjuvant Radiotherapy Timing on Survival Outcomes in High-Risk Patients Receiving Neoadjuvant Treatments

Cao

Wang

et al. 2022

Front. Oncol.

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PurposeTo determine the relationship between time to radiotherapy (TTR) and survival outcomes in breast cancer (BC) patients treated with neoadjuvant treatments (NATs).MethodsContinuous non-metastatic BC patients receiving NAT and adjuvant radiotherapy (RT) from 2009 to 2016 were retrospectively reviewed. A multivariable Cox model with restricted cubic splines (RCSs) was used to determine the panoramic relationship between TTR and survival outcomes. Multivariable analysis was used to control for confounding factors between the groups of TTR.ResultsA total of 315 patients were included. The RCS modeling demonstrated a non-linear relationship between TTR and survival outcomes. The lowest risk for distant metastasis-free survival (DMFS) and recurrence-free survival (RFS) was observed at the TTR of 12 weeks, and the lowest risk of BC-specific survival (BCSS) at 10 weeks. TTR was accordingly transformed into categorical variables as ≤10, 11–20, and >20 weeks. Multivariable analysis revealed that the TTR of ≤10 weeks was an independent prognostic factor for worse DMFS (HR = 2.294, 95% CI 1.079–4.881) and RFS (HR = 2.126, 95% CI 1.038–4.356) compared with the TTR of 10–20 weeks, while the is no difference in DMFS, RFS, and BCSS between TTR >20 weeks and TTR of 10–20 weeks.ConclusionThere exists a non-linear relationship between TTR after surgery and survival outcomes in patients treated with NAT. Early initiation of RT following surgery does not seem to be associated with a better therapeutic outcome. A relatively flexible recommendation of TTR could be adopted in clinical practice.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Influence of Adjuvant Radiotherapy Timing on Survival Outcomes in High-Risk Patients Receiving Neoadjuvant Treatments

Cao

Wang

et al. 2022

Front. Oncol.

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“…In hormone receptor-positive cancer, an interval of no more than 8–12 weeks should be observed [ 32 ]. Regarding adjuvant radiotherapy, the interval should also be kept as short as possible within the first twelve weeks postoperatively [ 27 , 29 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…For an optimal oncological outcome, the timely start of adjuvant treatment is essential [27][28][29]. A meta-analysis from Biagi et al demonstrated a 6% increased risk for death every 4 weeks of delay of the adjuvant chemotherapy [30].…”

Section: Interval Between Surgery and Adjuvant Treatmentmentioning

confidence: 99%

The impact of neoadjuvant systemic treatment on postoperative complications in breast cancer surgery

Nussbaumer

Maggi

Castrezana

et al. 2022

Breast Cancer Res Treat

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Purpose The aim of the study was to analyze the impact of neoadjuvant systemic treatment (NST) on postoperative complications and the beginning of adjuvant treatment. Methods This study includes data from a prospectively maintained database including patients with breast cancer (BC) stage I–IV with or without NST undergoing breast cancer surgery between January 2010 and September 2021. Results Out of 517 enrolled patients, 77 received NST, 440 had primary breast surgery. After NST patients underwent surgery after a meantime of 34 days (26.5–40 days). No statistical significance could be found comparing the complication grading according to the Clavien Dindo classification. The complications were most frequently rated as grade 3b. There were no complications with grade 4 or higher. When differentiating into short and long-term, the overall rate of short-term complications was 20.3% with no significant difference between the two groups (20.8% vs. 20.2%). Regarding long-term complications, there was more impairment of shoulder mobility (26.0% vs. 9.5%, p ≤ 0.001) and chronic pain (42.9% vs. 28.6%, p ≤ 0.016) for patients with NST. The beginning of the administration of the adjuvant treatment was comparable in both groups (46.3 days vs. 50.5 days). Conclusion In our cohort, complications between both groups were comparable according to Clavien Dindo. This study shows that NST has no negative impact on postoperative short-term complications and most importantly did not lead to a delay of the beginning of adjuvant treatment. Therefore, NST can be safely admitted, even when followed by extensive breast reconstruction surgery.

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“…For an optimal oncological outcome, the timely start of adjuvant treatment is essential. [27][28][29] Due to severe postoperative complications, initiation of adjuvant chemo-or radiotherapy may be delayed. In our study, we were able to show, that across all types of oncoplstic procedures, patients with NST started adjuvant treatment at the same time as patients undergoing primary surgery.…”

Section: Interval Between Nst and Surgerymentioning

confidence: 99%

The Impact of Neoadjuvant Systemic Treatment on Postoperative Complications in Breast Cancer Surgery

Maggi

Nussbaumer

Castrezana

et al. 2022

Preprint

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Purpose: The aim of the study was to analyse the impact of neoadjuvant systemic treatment (NST) on postoperative complications and the beginning of adjuvant treatment. Methods: This study includes data from a prospectively maintained database including patients with breast cancer (BC) stage I-IV with or without NST undergoing breast cancer surgery between January 2010 and September 2021. Results: Out of 517 enrolled patients, 77 received NST, 440 had primary breast surgery. After NST patients underwent surgery after a meantime of 34 days (26.5 – 40 days). No statistical significance could be found comparing the complication grading according to the Clavien Dindo classification. The complications were most frequently rated as grade 3b. There were no complications with grade 4 or higher. When differentiating into short and long-term, the overall rate of short-term complications was 20.3% with no significant difference between the two groups (20.8% vs. 20.2%). Regarding long-term complications, there was more impairment of shoulder mobility (26.0% vs. 9.5%, p = < 0.001) and chronic pain (42.9% vs. 28.6%, p = < 0.016) for patients with NST. The beginning of the administration of the adjuvant treatment was comparable in both groups (46.3 days vs. 50.5 days). Conclusion: In our cohort, complications between both groups were comparable according to Clavien Dindo. This study shows that NST has no negative impact on postoperative short-term complications and most importantly did not lead to a delay of the beginning of adjuvant treatment. Therefore, NST can be safely admitted, even when followed by extensive breast reconstruction surgery.

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Impact of time to initiation of postoperative radiotherapy after neoadjuvant chemotherapy on the prognosis of breast cancer: A retrospective cohort study in China

Cited by 4 publications

References 28 publications

Influence of Adjuvant Radiotherapy Timing on Survival Outcomes in High-Risk Patients Receiving Neoadjuvant Treatments

Influence of Adjuvant Radiotherapy Timing on Survival Outcomes in High-Risk Patients Receiving Neoadjuvant Treatments

The impact of neoadjuvant systemic treatment on postoperative complications in breast cancer surgery

The Impact of Neoadjuvant Systemic Treatment on Postoperative Complications in Breast Cancer Surgery

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