The Role of Postmastectomy Radiation Therapy (PMRT) in Clinical Stage II-III Breast Cancer Patients With pN0 After Neoadjuvant Chemotherapy: A Multicenter, Retrospective Study (KROG 12-05)

Shim, Su Jung; Won, Park Ji; Jae, H. Seong; Hwan, Shin Kyung; Ok, Schlappack; Ssan, K. Su; Soo, S. Hyun; Chang, Kidon; Hee, Kyung; Lee, Hyung-Sik

doi:10.1016/j.ijrobp.2013.06.572

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“…The role of post-operative radiotherapy following neoadjuvant chemotherapy for early breast cancer is uncertain and practice is far from uniform [ 7 , 10 ]. A rationale for a local radiotherapy only approach can be made from recurrence data from landmark non-NAC post mastectomy randomised control trials reporting the vast majority of LRR as local, and from both prospective and retrospective studies reporting low locoregional recurrence rates in selected groups post NAC and mastectomy without adjuvant radiotherapy [ 5 , 11 – 13 ]. The recognised morbidity of post-operative dedicated regional radiotherapy in addition to local radiotherapy may hence outweigh its benefit in some.…”

Section: Discussionmentioning

confidence: 99%

“…Cross study comparison is difficult. The majority of modern series exploring the exclusion of post-operative radiotherapy after NAC are conducted exclusively in ypN0 or pCR groups with arguably better outcomes [ 3 , 5 , 6 , 14 ]. Recurrence data from early NAC trials, prior to routine regional radiotherapy, report similar recurrence patterns in those who received breast conservation therapy and local radiotherapy despite consisting of only combined clinical stage I and II disease [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Local radiotherapy alone following neoadjuvant chemotherapy and surgery in combined clinical stage II and III breast cancer

White¹,

Dinneen²,

Makris

2016

Radiat Oncol

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PurposeThe outcomes and recurrence patterns for patients with combined clinical stage II and III breast cancer treated with local but not regional radiotherapy after neoadjuvant chemotherapy (NAC) and surgery are poorly documented.MethodsWe performed a retrospective review of a prospectively collected database comprised of breast cancer patients who received NAC at our institution. 172 patients met the specified criteria of receiving NAC, surgery inclusive of axillary nodal dissection and post-operative local (but not regional) radiotherapy.ResultsOne hundred eleven patients (64.5 %) were of combined clinical stage II and 61 (35.5 %) stage III at diagnosis. 103 patients (59.9 %) were clinically node positive with 101 cN1. On post-NAC pathology 29 (16.9 %) patients had a complete response, 30 (17.6 %) were combined yp stage I, 104 (60.5 %) yp stage II and 9 (5.2 %) yp stage III. 77 (44.8 %) were node positive on post-NAC pathology, all ypN1. 52.3 % were treated with breast conservation. At a median follow up of 67 months, 56 patients experienced breast cancer recurrence and 47 had died with breast cancer the dominant cause. Actuarial 5 and 10 year estimated freedom from locoregional recurrence (FFLRR), freedom from distant metastases (FFDM), disease free (DFS) and overall survival (OS) were 90 and 83.5, 74.5 and 64, 69.5 and 56, 79.5 and 65 % respectively. The most common pattern of failure was distant alone (without local or regional failure). Regional failure as the only site of first failure occurred in just three patients but was a component of first failure in a further twelve. Predictive factors on multivariate analysis for FFLRR were clinical stage II and estrogen receptor positivity. Prognostic factors were ypN0 stage and estrogen receptor positive status.ConclusionsLocal radiotherapy alone may be reasonable for selected patients. Isolated distant recurrence is the dominant mode of failure for breast cancer patients who have received local radiotherapy without regional coverage following NAC.

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