Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy.

Abstract

PURPOSE:

The aim of this study was to investigate the role of postmastectomy radiation therapy in women with breast cancer who achieved a pathologic complete response (pCR) to neoadjuvant chemotherapy.

METHODS AND MATERIALS:

We retrospectively identified 226 patients treated at our institution who achieved a pCR at surgery after receiving neoadjuvant chemotherapy. Of these, the 106 patients without inflammatory breast cancer who were treated with mastectomy were analyzed. The patients' clinical stages at diagnosis were I in 2%, II in 31%, IIIA in 30%, IIIB in 25%, and IIIC in 11% (American Joint Committee on Cancer 2003 system). Of the patients, 92% received anthracycline-based chemotherapy, and 38% also received a taxane. A total of 72 patients received postmastectomy radiation therapy, and 34 did not. The actuarial rates of local-regional recurrence (LRR) and survival of the two groups were compared using the log-rank test.

RESULTS:

The median follow-up of surviving patients was 62 months. Use of radiation therapy did not affect the 10-year rates of LRR for patients with Stage I or II disease (the 10-year LRR rates were 0% for both groups). However, the 10-year LRR rate for patients with Stage III disease was significantly improved with radiation therapy (7.3% +/- 3.5% with vs. 33.3% +/- 15.7% without; p = 0.040). Within this cohort, use of radiation therapy was also associated with improved disease-specific and overall survival.

CONCLUSION:

Postmastectomy radiation therapy provides a significant clinical benefit for breast cancer patients who present with clinical Stage III disease and achieve a pCR after neoadjuvant chemotherapy.

• Authors: Sean E McGuire, Ana M Gonzalez-Angulo, Eugene H Huang, Susan L Tucker, Shu-Wan C Kau, Tse-Kuan Yu, Eric A Strom, Julia L Oh, Wendy A Woodward, Welela Tereffe, Kelly K Hunt, Henry M Kuerer, Aysegul A Sahin, Gabriel N Hortobagyi, Thomas A Buchholz
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 68 Issue 4 Pg. 1004-9 (Jul 15 2007) ISSN: 0360-3016 [Print] United States
• PMID: 17418973 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents

Topics

• Adult
• Aged
• Analysis of Variance
• Antineoplastic Agents (therapeutic use)
• Breast Neoplasms (drug therapy, pathology, radiotherapy, surgery)
• Chemotherapy, Adjuvant
• Female
• Humans
• Mastectomy
• Middle Aged
• Neoadjuvant Therapy
• Retrospective Studies
• Survival Analysis
• Treatment Outcome