The Importance of Postoperative Radiation Therapy in Multimodality Management of Locally Advanced Breast Cancer: A Phase II Trial of Neoadjuvant MVAC, Surgery, and Radiation

Abdel‐Wahab, May; Wolfson, Aaron H.; Raub, William; Mies, Carolyn; Brandon, Alfred H.; Morrell, Louise; Lee, Young; Ling, Stella; Markoe, Arnold M.

doi:10.1016/s0360-3016(97)00897-3

Cited by 36 publications

(12 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The clinical stage is an important factor indicating the risk of OS, LRR, and DM ( Table 2 , Table 3 , Table 4 ). Our findings were compatible with previous studies [ [32] , [33] , [34] , [35] , [36] , [37] , [38] ]. Retrospective data of women with clinical stage III receiving PMRT have indicated improved local control even for patients who had a pCR to NACT [ 32 , 34 , 37 , 38 ].…”

Section: Discussionsupporting

confidence: 94%

“…2 ). Our findings were compatible with some retrospective studies, indicating that PMRT is beneficial for lowering LRR irrespective of the pathologic response [ [32] , [33] , [34] , [35] , [36] , [37] , [38] ]. In addition, PMRT is not significant for the reduction of DM risk in patients with breast cancer receiving NACT and TM ( Supplemental Figure 1 ).…”

Section: Discussionsupporting

confidence: 92%

“…However, the definitive indications of adjuvant PMRT are controversial in these patients [ 14 , 15 ]; clinical stages did not provide convincing evidence for performing PMRT in patients with breast cancer who have received NACT and TM [ [32] , [33] , [34] , [35] , [36] , [37] , [38] ]. Because controversy exists regarding clinical stages for indicating PMRT [ 14 , 15 , [32] , [33] , [34] , [35] , [36] , [37] , [38] ], pathologic tumor or nodal stages might be important basic references for further PMRT in patients with breast cancer receiving NACT and TM. Therefore, we focused on the pathologic stages after NACT as indicators for performing further PMRT in these patients.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of pathologic stages on postmastectomy radiation therapy in breast cancer receiving neoadjuvant chemotherapy and total mastectomy: A Cancer Database Analysis

Zhang

Chen

et al. 2020

The Breast

View full text Add to dashboard Cite

Purpose To use pathologic indicators to determine which patients benefit from postmastectomy radiation therapy (PMRT) for breast cancer after neoadjuvant chemotherapy (NACT) and total mastectomy (TM). Patients and methods We enrolled 4236 patients with breast invasive ductal carcinoma who received NACT followed by TM. Cox regression analysis was used to calculate hazard ratios (HRs) and confidence intervals; independent predictors were controlled for or stratified in the analysis. Results After multivariate Cox regression analyses, the adjusted HRs derived for PMRT for all-cause mortality were 0.65 (0.52–0.81, P < 0.0001) and 0.58 (0.47–0.71, P < 0.0001) in postchemotherapy pathologic tumor stages T2–4 (ypT3–4) and postchemotherapy pathologic nodal stages N2–3 (ypN2–3), respectively. Moreover, adjusted HRs derived for PMRT with all-cause mortality were 0.51 (0.38–0.69, P < 0.0001), 0.60 (0.40–0.88, P = 0.0096), and 0.64 (0.48–0.86, P = 0.0024) in pathological stages IIIA, IIIB, and IIIC, respectively. Additionally, the PMRT group showed significant locoregional control irrespective of the pathologic response, even ypT0, ypN0, or pathological complete response (pCR), compared with the No-PMRT group. The multivariate analysis showed no statistical differences between the PMRT and No-PMRT groups for distant metastasis-free survival in any pathologic response of ypT0–4, ypN0–3, and pathologic American Joint Committee on Cancer stages pCR to IIIC. Conclusion For patients with breast cancer ypT3–4, ypN2–3, or pathologic stages IIIA–IIIC receiving NACT and TM, benefit from PMRT if it is associated with OS benefits, regardless of the clinical stage of the disease. Compared with No-PMRT, PMRT improved locoregional recurrence-free survival, even pCR, in patients with breast cancer receiving NACT and TM.

show abstract

Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of pathologic stages on postmastectomy radiation therapy in breast cancer receiving neoadjuvant chemotherapy and total mastectomy: A Cancer Database Analysis

Zhang

Chen

et al. 2020

The Breast

View full text Add to dashboard Cite

show abstract

“…However, in stage II or stage III disease who achieve a nodal pCR, specific features possibly portending higher LRR rates such as residual breast disease, young patient age, may support the necessity for PMRT [70]. Locoregional control and overall survival benefit with PMRT after NAC was reported in one of the earliest studies on this issue by Abdel-Wahab et al [83] which investigated 55 breast cancer patients with cT3-4 or cN2-3 [83]. After 47 months of median follow up LRR rates were 7% and 31% for patients with and without PMRT respectively which turned out a 3-year OS benefit (88% versus 46%).…”

Section: Indications For Pmrt In Neoadjuvant Approachmentioning

confidence: 99%

Radiation Therapy Decision and Field Design after Neoadjuvant Chemotherapy in Breast Cancer: A Review of Neoadjuvant Approach

Özkan

2021

CTOIJ

View full text Add to dashboard Cite

NAC was compared with the same chemotherapy given postoperatively in plenty of randomized trials [12][13][14][15][16]. Accurate interpretation of these data is hardly available because: firstly, frequency of breast-conserving surgery differed between groups and in some trials [17,18] some of the good responders even did not receive surgery. Second drawback is substantial downstaging bias caused by analysis of postsurgical characteristics data in

show abstract

“…Although a few retrospective studies have suggested that an initial clinical stage or treatment response (ie, pathological complete response [pCR] of the primary tumor and lymph node metastasis or no evidence of residual pathologic nodal disease [ypN0])) is associated with good locoregional control, whether patients could omit PMRT remains controversial. 12 , 13 , 14 , 15 , 16 Many studies were conducted on patients before the standard use of aromatase inhibitors, trastuzumab, and anthracycline/taxane-based chemotherapy, which have improved clinical outcomes in adjuvant settings. 17 , 18 , 19 , 20 …”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes and prognostic factors in patients with stage II-III breast cancer treated with neoadjuvant chemotherapy followed by surgery and postmastectomy radiation therapy in the modern treatment era

Nakajima

Oguchi

Kumai

et al. 2018

Advances in Radiation Oncology

View full text Add to dashboard Cite

PurposeThere are no randomized studies on the indication for postmastectomy radiation therapy (PMRT) in patients who receive neoadjuvant chemotherapy (NAC) followed by a mastectomy. The aim of this study was to determine clinical outcomes and identify reliable prognostic factors in patients with locally advanced breast cancer treated with NAC followed by a mastectomy and PMRT.Methods and materialsWe retrospectively evaluated the relationship between clinicopathological factors and outcomes in 351 patients with stage II or III breast cancer who underwent NAC followed by radical mastectomy and PMRT between March 2005 and December 2013.ResultsThe median follow-up duration was 81 months (Range, 12-156 months). For all patients, the 5-year locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 91.3 %, 69.8 %, and 83.4 %, respectively. On multivariate analysis, estrogen-receptor positivity, and complete response of cancer in axillary nodes (ypN0) were significant prognostic factors for better LRFS, while lympho-vascular invasion and clinical stage IIIC were independent prognostic factors for worse LRFS. The number of axillary node metastasesafter surgery was an independent prognostic factor of DMFS and OS. Patients with hormone receptor- and human epidermal growth factor receptor 2 positivity had significantly better 5-year LRFS rates.ConclusionsWe identified several prognostic factors in our study. In particular, the number of axillary node metastases is significantly related to OS.

show abstract

The Importance of Postoperative Radiation Therapy in Multimodality Management of Locally Advanced Breast Cancer: A Phase II Trial of Neoadjuvant MVAC, Surgery, and Radiation

Cited by 36 publications

References 19 publications

Effect of pathologic stages on postmastectomy radiation therapy in breast cancer receiving neoadjuvant chemotherapy and total mastectomy: A Cancer Database Analysis

Effect of pathologic stages on postmastectomy radiation therapy in breast cancer receiving neoadjuvant chemotherapy and total mastectomy: A Cancer Database Analysis

Radiation Therapy Decision and Field Design after Neoadjuvant Chemotherapy in Breast Cancer: A Review of Neoadjuvant Approach

Clinical outcomes and prognostic factors in patients with stage II-III breast cancer treated with neoadjuvant chemotherapy followed by surgery and postmastectomy radiation therapy in the modern treatment era

Contact Info

Product

Resources

About