Su Jung Shim1, Won Park2, Seung Jae Huh3, Doo Ho Choi3, Kyung Hwan Shin4, Nam Kwon Lee5, Chang-Ok Suh6, Ki Chang Keum6, Yong Bae Kim6, Seung Do Ahn7, Su Ssan Kim7, Sung W Ha8, Eui Kyu Chie8, Kyubo Kim8, Hyun Soo Shin9, Jin Hee Kim10, Hyung-Sik Lee11. 1. Department of Radiation Oncology, Eulji General Hospital, College of Medicine, Eulji University, Seoul, Republic of Korea. 2. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: wonro.park@samsung.com. 3. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 4. Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea. 5. Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea; Department of Radiation Oncology, Korea Medical Center, Korea University, School of Medicine, Seoul, Republic of Korea. 6. Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. 7. Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea. 8. Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea. 9. Department of Radiation Oncology, Bundang CHA Hospital, School of Medicine, CHA University, Seongnam, Republic of Korea. 10. Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea. 11. Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan, Republic of Korea.
Abstract
PURPOSE: The purpose of this study was to investigate the role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) in clinical stage II-III breast cancer patients with pN0. METHODS AND MATERIALS: We retrospectively identified 417 clinical stage II-III breast cancer patients who achieved an ypN0 at surgery after receiving NAC between 1998 and 2009. Of these, 151 patients underwent mastectomy after NAC. The effect of PMRT on disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and overall survival (OS) was evaluated by multivariate analysis including known prognostic factors using the Kaplan-Meier method and compared using the log-rank test and Cox proportional regression analysis. RESULTS: Of the 151 patients who underwent mastectomy, 105 (69.5%) received PMRT and 46 patients (30.5%) did not. At a median follow-up of 59 months, 5 patients (3.3%) developed LRR (8 sites of recurrence) and 14 patients (9.3%) developed distant metastasis. The 5-year DFS, LRRFS, and OS rates were 91.2, 98.1, and 93.3% with PMRT and 83.0%, 92.3%, and 89.9% without PMRT, respectively (all P values not significant). By univariate analysis, only age (≤40 vs >40 years) was significantly associated with decreased DFS (P=.027). By multivariate analysis, age (≤40 vs >40 years) and pathologic T stage (0-is vs 1 vs 2-4) were significant prognostic factors affecting DFS (hazard ratio [HR] 0.353, 95% confidence interval [CI] 0.135-0.928, P=.035; HR 2.223, 95% CI 1.074-4.604, P=.031, respectively). PMRT showed no correlation with a difference in DFS, LRRFS, or OS by multivariate analysis. CONCLUSIONS: PMRT might not be necessary for pN0 patients after NAC, regardless of clinical stage. Prospective randomized clinical trial data are needed to assess whether PMRT can be safely omitted in pN0 patients after NAC and mastectomy for clinical stage II-III breast cancer.
PURPOSE: The purpose of this study was to investigate the role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) in clinical stage II-III breast cancerpatients with pN0. METHODS AND MATERIALS: We retrospectively identified 417 clinical stage II-III breast cancerpatients who achieved an ypN0 at surgery after receiving NAC between 1998 and 2009. Of these, 151 patients underwent mastectomy after NAC. The effect of PMRT on disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and overall survival (OS) was evaluated by multivariate analysis including known prognostic factors using the Kaplan-Meier method and compared using the log-rank test and Cox proportional regression analysis. RESULTS: Of the 151 patients who underwent mastectomy, 105 (69.5%) received PMRT and 46 patients (30.5%) did not. At a median follow-up of 59 months, 5 patients (3.3%) developed LRR (8 sites of recurrence) and 14 patients (9.3%) developed distant metastasis. The 5-year DFS, LRRFS, and OS rates were 91.2, 98.1, and 93.3% with PMRT and 83.0%, 92.3%, and 89.9% without PMRT, respectively (all P values not significant). By univariate analysis, only age (≤40 vs >40 years) was significantly associated with decreased DFS (P=.027). By multivariate analysis, age (≤40 vs >40 years) and pathologic T stage (0-is vs 1 vs 2-4) were significant prognostic factors affecting DFS (hazard ratio [HR] 0.353, 95% confidence interval [CI] 0.135-0.928, P=.035; HR 2.223, 95% CI 1.074-4.604, P=.031, respectively). PMRT showed no correlation with a difference in DFS, LRRFS, or OS by multivariate analysis. CONCLUSIONS: PMRT might not be necessary for pN0 patients after NAC, regardless of clinical stage. Prospective randomized clinical trial data are needed to assess whether PMRT can be safely omitted in pN0 patients after NAC and mastectomy for clinical stage II-III breast cancer.
Authors: David Krug; René Baumann; Wilfried Budach; Jürgen Dunst; Petra Feyer; Rainer Fietkau; Wulf Haase; Wolfgang Harms; Thomas Hehr; Marc D Piroth; Felix Sedlmayer; Rainer Souchon; Frederik Wenz; Rolf Sauer Journal: Strahlenther Onkol Date: 2018-01-30 Impact factor: 3.621
Authors: Frederik Wenz; Elena Sperk; Wilfried Budach; Jürgen Dunst; Petra Feyer; Rainer Fietkau; Wulf Haase; Wolfgang Harms; Marc D Piroth; Marie-Luise Sautter-Bihl; Felix Sedlmayer; Rainer Souchon; Christoph Fussl; Rolf Sauer Journal: Strahlenther Onkol Date: 2014-08 Impact factor: 3.621
Authors: J M Noh; W Park; C-O Suh; K C Keum; Y B Kim; K H Shin; K Kim; E K Chie; S W Ha; S S Kim; S D Ahn; H S Shin; J H Kim; H-S Lee; N K Lee; S J Huh; D H Choi Journal: Br J Cancer Date: 2014-01-30 Impact factor: 7.640