The Benefit of Post-Mastectomy Radiotherapy in ypN0 Patients after Neoadjuvant Chemotherapy According to Molecular Subtypes

Cho, Wonkyung; Park, Won; Choi, Doo Ho; Kim, Yong Bae; Kim, Jin Ho; Kim, Su Ssan; Kim, Kyubo; Kim, Jin Hee; Ahn, Sung‐Ju; Lee, Sun Young; Lee, Jeongshim; Kim, Sang Won; Kwon, Junhyun; Ahn, Ki Jung

doi:10.4048/jbc.2019.22.e25

Cited by 18 publications

(20 citation statements)

References 22 publications

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“…A total of 189 patients were included in this analysis, and the effects of PMRT on locoregional control, DFS, and OS were evaluated. However, PMRT provides no additional survival benefits for any molecular subtype [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Postmastectomy Radiotherapy on Locoregional Control and Disease-Free Survival in Patients with Breast Cancer Treated with Neoadjuvant Chemotherapy

Zhang

Zhuang

et al. 2021

Journal of Oncology

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Background. The impact of postmastectomy radiotherapy (PMRT) in patients receiving neoadjuvant chemotherapy (NAC) is unclear. The purpose of this study is to identify the patients who may benefit from PMRT. Methods. We retrospectively analysed patients with clinical stage II-III breast cancer who underwent NAC and modified radical mastectomy at our centre from 2007 to 2015. We investigated the relationship amongst locoregional recurrence rate (LRR), disease-free survival (DFS), and clinical pathological characters. Results. A total of 554 patients were analysed in this study. The median follow-up time was 65 months. Amongst the patients, 58 (10.5%) had locoregional recurrence, 138 (24.9%) had distant metastasis, and 72 (13.0%) patients died. The 5-year cumulative incidence of LRR and DFS was 9.2% and 74.2%, respectively. A total of 399 (72%) patients received PMRT and 155 (28%) did not. The 5-year LRR of the patients with PMRT (7.3% vs. 14.1%, P = 0.01 ) decreased significantly. We found that PMRT was an independent prognostic factor of LRR and DFS. Patients with the persistent involvement of 1–3 lymph nodes (ypN1) and more than 4 positive lymph nodes (ypN2-3) had a better outcome after PMRT than those without. However, the LRR and DFS of patients with negative lymph nodes at the time of surgery (ypN0) and who received PMRT showed no significant benefits. Amongst all patients with the three molecular subtypes of breast cancer, patients with triple-negative breast cancer had the highest pathological complete response rate but the worst prognosis ( P = 0.001 ). Conclusion. Results showed that PMRT significantly reduced the LRR of patients with clinical stage II-III breast cancer after receiving NAC and mastectomy. YpN0 patients derived no local control or survival benefit after receiving PMRT, whereas those with ypN1 and ypN2-3 could obviously benefit from PMRT.

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Section: Discussionmentioning

confidence: 99%

Impact of Postmastectomy Radiotherapy on Locoregional Control and Disease-Free Survival in Patients with Breast Cancer Treated with Neoadjuvant Chemotherapy

Zhang

Zhuang

et al. 2021

Journal of Oncology

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“…The initial search on PubMed yielded 1837 studies. After applying the inclusion and exclusion criteria, 13 studies were included in the meta-analysis [13] , [14] , [15] , [16] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] . Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The analysis on the impact of LRRT on LRR included six studies ( Fig. 2 A) [15] , [20] , [21] , [22] , [23] , [24] . In total, 2388 patients with N+ at diagnosis and ypN0 after NACT were included in the analysis, 859 received LRRT and 1529 did not.…”

Section: Resultsmentioning

confidence: 99%

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

Nikyar

Tegnelius

Valachis

2022

Clinical and Translational Radiation Oncology

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The aim of the present meta-analysis was to investigate the impact of adjuvant locoregional radiation therapy (LRRT) in breast cancer patients with clinical lymph node metastatic disease achieving ypN0 after neoadjuvant chemotherapy (NACT). Materials and methods: A systematic review of studies on PubMed was performed. A meta-analysis was conducted by computing extracted hazard ratios (HRs) and 95% confidence intervals (CIs) into a fixed-effects model. Results: Thirteen studies were included in the meta-analysis. Adjuvant LRRT significantly reduced the risk of locoregional recurrence (LRR) in patients with N+ at diagnosis and ypN0 (HR 0.59; 95% CI 0.42-0.81). However, no statistically significant difference on disease-free survival (DFS) or overall survival (OS) was found. Conclusions: LRRT significantly reduced the risk of LRR in patients with ypN0 after NACT whereas no impact on DFS or OS was observed. The low level of evidence should be considered when interpreting the results in clinical practice.

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“…Several previous studies have determined a subpopulation of patients who benefited from PMRT, among those who received NAC. Scodan et al and Cho et al suggested that PMRT is beneficial in patients with ypN+ disease after receiving NAC, but not in those with ypN0 disease [ 21 , 29 ]. Furthermore, some researchers argued that PMRT can also be omitted in patients with ypN1 disease [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, although no definite criteria have been established regarding the need for PMRT after NAC, several retrospective studies have performed this treatment [ 18 , 19 , 20 , 21 ]. As patients with a good response to chemotherapy have a better prognosis, the need for irradiation in these patients should be discussed, although existing guidelines recommend that the need for PMRT should be based on the pre-NAC staging [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Post-Mastectomy Radiotherapy on Survival Outcomes in Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy

Lee

Kim

Bae

et al. 2021

Cancers

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This study aimed to determine whether post-mastectomy radiotherapy (PMRT) is beneficial for the prognosis of patients who achieved pathologic complete response (pCR), or who had minimal residual disease, after undergoing neoadjuvant chemotherapy (NAC). Patients who underwent a total mastectomy between 2006 and 2018, after NAC, were included. Patients who did not receive PMRT were matched using 1:3 propensity score matching (PSM). Kaplan–Meier survival curves were used to compare locoregional recurrence-free survival (LRRFS) and overall survival (OS). A total of 368 patients were included after 1:3 PSM. PMRT improved the LRRFS (p = 0.016) and OS (p = 0.017) rates of patients who underwent NAC. However, PMRT did not affect the prognosis of patients with pCR (LRRFS: p = 0.999; OS: p = 0.453). In addition, PMRT had a limited effect on LRRFS and OS in patients who responded well to NAC, with a neoadjuvant response index (NRI) value of 0.7–1.0 (LRRFS: p = 0.568; OS: p = 0.875). PMRT improved the OS of patients with a large residual tumor burden, such as nodal metastases or pathologic stage II/III. The benefits of PMRT vary depending on the patients’ response to NAC, although PMRT is useful for treating patients who underwent NAC. PMRT can be omitted, not only in patients with pCR, but also in good responders with an NRI value of 0.7–1.0.

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The Benefit of Post-Mastectomy Radiotherapy in ypN0 Patients after Neoadjuvant Chemotherapy According to Molecular Subtypes

Cited by 18 publications

References 22 publications

Impact of Postmastectomy Radiotherapy on Locoregional Control and Disease-Free Survival in Patients with Breast Cancer Treated with Neoadjuvant Chemotherapy

Impact of Postmastectomy Radiotherapy on Locoregional Control and Disease-Free Survival in Patients with Breast Cancer Treated with Neoadjuvant Chemotherapy

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

The Impact of Post-Mastectomy Radiotherapy on Survival Outcomes in Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy

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