Role of Postmastectomy Radiation After Neoadjuvant Chemotherapy in Stage II-III Breast Cancer

Post-mastectomy radiotherapy after neodjuvant chemotherapy in breast cancer patients: A review

“…The Fowble et al [24] data were later on confirmed by the data retrieved by Mamounas et al [1] In NSABP B-18, 1523 Table 1 Classes and types of unfavourable risk factors in breast cancer patients treated with neoadjuvant chemotherapy and mastectomy.…”

“…Table 1 lists the main variables identified in the literature on post-NAC PMRT [1][2][3][12][13][14][19][20][21][22][23][24][25][26][27][28]. There are a high number of host-, disease-and treatment-related parameters shown to reach statistically significant levels and, in terms of treatment outcome, their relevance quite markedly vary among the reports, even for those published in a recent past.…”

“…In an attempt to provide a clearer definition of the post-NAC PMRT indications, Fowble et al [24] recently tried to determine which patients which patients would not need it. For this, appropriateness ratings for postmastectomy radiation were assigned to 14 hypothetical clinical case scenarios, using the American College of Radiology appropriateness criteria.…”

Quels volumes d’irradiation ganglionnaire après chimiothérapie néoadjuvante des cancers du sein ?

“…En 2012, l'équipe californienne de B. Fowble a proposé un outil décisionnel reposant sur une estimation du risque de récidive locorégionale en tenant compte des caractéristiques cliniques et histopathologiques de la maladie, du stade initial, de l'âge, ainsi que de la réponse histologique à la chimiothérapie néoadjuvante [22]. Les auteurs y identifiaient une population à faible risque de récidive locorégionale (inférieure ou égale à 10 %) pour laquelle ils proposent de ne pas retenir d'indication de radiothérapie : patientes de plus de 40 ans, stades T1 N0-1 et T2N0, avec une réponse histologique complète mammaire ou ganglionnaire, récepteurs aux estrogènes exprimés, sans embole vasculaire ni composante intracanalaire extensive.…”

The Japanese Breast Cancer Society clinical practice guideline for radiotherapy of breast cancer

“…Although there is no high-level evidence, PMRT is recommended based on the pretreatment tumor characteristics in patients with advanced breast cancer even if a good response is achieved by the chemotherapy [49].…”