T Jonathan Yang1, Monica Morrow2, Shanu Modi3, Zhigang Zhang4, Kate Krause1, Chun Siu1, Beryl McCormick1, Simon N Powell1, Alice Y Ho5. 1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 2. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3. Breast Oncology Service, Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. hoa1234@mskcc.org.
Abstract
BACKGROUND: The relative contribution of biologic subtype to locoregional recurrence (LRR) in patients treated with neoadjuvant chemotherapy (NAC), mastectomy, and postmastectomy radiotherapy (PMRT) is not clearly defined. METHODS: 233 patients with stages 2 and 3 breast cancer who received NAC, mastectomy, and PMRT between 2000 and 2009 were included: 53 % (n = 123) had HR+ (ER or PR+/HER2-), 23 % (n = 53) had HER2+ (HER2+/HR+ or HR-), and 24 % (n = 57) had triple-negative (TN) disease (HR-/HER2-). The 5-year LRR rates were estimated by Kaplan-Meier methods. Cox regression analysis was performed to evaluate covariates associated with LRR. RESULTS: The median follow-up period was 62 months. A pathologic complete response (pCR) was seen in 14 % of the patients. The 5-year LRR rate was 8 % for the entire cohort. The LRR rate was 0 % for the patients with a pCR versus 9 % for the patients without a pCR (p = 0.05). TN disease [Hazard ratio (HR) 4.4; p = 0.003] and pathologic node positivity (HR 9.8; p = 0.03) were associated with LRR. Patients with TN disease had a higher LRR rate than patients with HER2+ or HR+ disease (20 vs. 6 and 4 %; p = 0.005). Among patients without a pCR, TN subtype was associated with increased LRR risk (26 versus 7 % HER+ and 4 % HR+; p < 0.001). CONCLUSIONS: Patients with TN breast cancer had the highest LRR rate after NAC, mastectomy and PMRT. Whereas no LRR was observed among TN patients with a pCR, TN patients with residual disease had a significantly higher LRR risk. Patients with HR+ and HER2+ breast cancer had favorable LRR rates regardless of NAC response, likely due to receipt of adjuvant systemic targeted therapies.
BACKGROUND: The relative contribution of biologic subtype to locoregional recurrence (LRR) in patients treated with neoadjuvant chemotherapy (NAC), mastectomy, and postmastectomy radiotherapy (PMRT) is not clearly defined. METHODS: 233 patients with stages 2 and 3 breast cancer who received NAC, mastectomy, and PMRT between 2000 and 2009 were included: 53 % (n = 123) had HR+ (ER or PR+/HER2-), 23 % (n = 53) had HER2+ (HER2+/HR+ or HR-), and 24 % (n = 57) had triple-negative (TN) disease (HR-/HER2-). The 5-year LRR rates were estimated by Kaplan-Meier methods. Cox regression analysis was performed to evaluate covariates associated with LRR. RESULTS: The median follow-up period was 62 months. A pathologic complete response (pCR) was seen in 14 % of the patients. The 5-year LRR rate was 8 % for the entire cohort. The LRR rate was 0 % for the patients with a pCR versus 9 % for the patients without a pCR (p = 0.05). TN disease [Hazard ratio (HR) 4.4; p = 0.003] and pathologic node positivity (HR 9.8; p = 0.03) were associated with LRR. Patients with TN disease had a higher LRR rate than patients with HER2+ or HR+ disease (20 vs. 6 and 4 %; p = 0.005). Among patients without a pCR, TN subtype was associated with increased LRR risk (26 versus 7 % HER+ and 4 % HR+; p < 0.001). CONCLUSIONS:Patients with TN breast cancer had the highest LRR rate after NAC, mastectomy and PMRT. Whereas no LRR was observed among TNpatients with a pCR, TNpatients with residual disease had a significantly higher LRR risk. Patients with HR+ and HER2+ breast cancer had favorable LRR rates regardless of NAC response, likely due to receipt of adjuvant systemic targeted therapies.
Authors: Himanshu Nagar; Elizabeth A Mittendorf; Eric A Strom; George H Perkins; Julia L Oh; Welela Tereffe; Wendy A Woodward; Ana M Gonzalez-Angulo; Kelly K Hunt; Thomas A Buchholz; Tse-Kuan Yu Journal: Int J Radiat Oncol Biol Phys Date: 2011-08-30 Impact factor: 7.038
Authors: Joseph Ragaz; Ivo A Olivotto; John J Spinelli; Norman Phillips; Stewart M Jackson; Kenneth S Wilson; Margaret A Knowling; Christopher M L Coppin; Lorna Weir; Karen Gelmon; Nhu Le; Ralph Durand; Andrew J Coldman; Mohamed Manji Journal: J Natl Cancer Inst Date: 2005-01-19 Impact factor: 13.506
Authors: M Overgaard; M B Jensen; J Overgaard; P S Hansen; C Rose; M Andersson; C Kamby; M Kjaer; C C Gadeberg; B B Rasmussen; M Blichert-Toft; H T Mouridsen Journal: Lancet Date: 1999-05-15 Impact factor: 79.321
Authors: M Overgaard; P S Hansen; J Overgaard; C Rose; M Andersson; F Bach; M Kjaer; C C Gadeberg; H T Mouridsen; M B Jensen; K Zedeler Journal: N Engl J Med Date: 1997-10-02 Impact factor: 91.245
Authors: Eleftherios P Mamounas; Stewart J Anderson; James J Dignam; Harry D Bear; Thomas B Julian; Charles E Geyer; Alphonse Taghian; D Lawrence Wickerham; Norman Wolmark Journal: J Clin Oncol Date: 2012-10-01 Impact factor: 44.544
Authors: W Fraser Symmans; Florentia Peintinger; Christos Hatzis; Radhika Rajan; Henry Kuerer; Vicente Valero; Lina Assad; Anna Poniecka; Bryan Hennessy; Marjorie Green; Aman U Buzdar; S Eva Singletary; Gabriel N Hortobagyi; Lajos Pusztai Journal: J Clin Oncol Date: 2007-09-04 Impact factor: 44.544
Authors: Joel S Parker; Michael Mullins; Maggie C U Cheang; Samuel Leung; David Voduc; Tammi Vickery; Sherri Davies; Christiane Fauron; Xiaping He; Zhiyuan Hu; John F Quackenbush; Inge J Stijleman; Juan Palazzo; J S Marron; Andrew B Nobel; Elaine Mardis; Torsten O Nielsen; Matthew J Ellis; Charles M Perou; Philip S Bernard Journal: J Clin Oncol Date: 2009-02-09 Impact factor: 44.544
Authors: Cornelia Liedtke; Chafika Mazouni; Kenneth R Hess; Fabrice André; Attila Tordai; Jaime A Mejia; W Fraser Symmans; Ana M Gonzalez-Angulo; Bryan Hennessy; Marjorie Green; Massimo Cristofanilli; Gabriel N Hortobagyi; Lajos Pusztai Journal: J Clin Oncol Date: 2008-02-04 Impact factor: 44.544
Authors: Abigail S Caudle; Tse-Kuan Yu; Susan L Tucker; Isabelle Bedrosian; Jennifer K Litton; Ana M Gonzalez-Angulo; Karen Hoffman; Funda Meric-Bernstam; Kelly K Hunt; Thomas A Buchholz; Elizabeth A Mittendorf Journal: Breast Cancer Res Date: 2012-05-23 Impact factor: 6.466
Authors: Judy C Boughey; Karla V Ballman; Linda M McCall; Elizabeth A Mittendorf; William Fraser Symmans; Thomas B Julian; David Byrd; Kelly K Hunt Journal: Ann Surg Date: 2017-10 Impact factor: 12.969
Authors: Xinyi Tu; Mohamed M Kahila; Qin Zhou; Jia Yu; Krishna R Kalari; Liewei Wang; William S Harmsen; Jian Yuan; Judy C Boughey; Matthew P Goetz; Jann N Sarkaria; Zhenkun Lou; Robert W Mutter Journal: Mol Cancer Ther Date: 2018-08-30 Impact factor: 6.261
Authors: Won Kyung Cho; Doo Ho Choi; Won Park; Haeyoung Kim; Seonwoo Kim; Myung-Hee Shin; Hyejung Cha Journal: J Breast Cancer Date: 2019-09-23 Impact factor: 3.588
Authors: J M Simons; L B Koppert; E J T Luiten; C C van der Pol; S Samiei; J H W de Wilt; S Siesling; M L Smidt Journal: Breast Cancer Res Treat Date: 2020-03-16 Impact factor: 4.872