David Krug1,2,3, Bianca Lederer4, Fenja Seither4, Valentina Nekljudova4, Beyhan Ataseven5, Jens-Uwe Blohmer6, Serban Dan Costa7, Carsten Denkert8, Nina Ditsch9, Bernd Gerber10, Claus Hanusch11, Joerg Heil12, Jörn Hilfrich13, Jens B Huober14, Christian Jackisch15, Sherko Kümmel16, Stefan Paepke17, Christian Schem18, Andreas Schneeweiss19, Michael Untch20, Jürgen Debus21,22, Gunter von Minckwitz4, Thorsten Kühn23, Sibylle Loibl4. 1. Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany. david.krug@uksh.de. 2. National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany. david.krug@uksh.de. 3. Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. david.krug@uksh.de. 4. German Breast Group, Neu-Isenburg, Germany. 5. Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany. 6. Charité, Klinik für Gynäkologie, Berlin, Germany. 7. Universitätsklinikum Magdeburg, Universitätsfrauenklinik, Magdeburg, Germany. 8. Institute for Pathology, Philipps-University Marburg, Marburg, Germany. 9. Department of Obstetrics and Gynecology, Ludwig-Maximilians-University of Munich, Munich, Germany. 10. Department of Gynecology and Obstetrics, University Hospital, Rostock, Germany. 11. Rotkreuzklinikum München, Frauenklinik, Munich, Germany. 12. Breast Unit, University Hospital, University of Heidelberg, Heidelberg, Germany. 13. Frauenklinik Henriettenstiftung, Hannover, Germany. 14. Universitätsklinikum Ulm, Universitätsfrauenklinik, Ulm, Germany. 15. Sana Klinikum Offenbach, Klinik für Gynäkologie und Geburtshilfe, Offenbach, Germany. 16. Breast Unit, Kliniken Essen-Mitte, Essen, Germany. 17. Klinikum rechts der Isar TU München, Frauenklinik und Poliklinik, Munich, Germany. 18. Mammazentrum Hamburg, Hamburg, Germany. 19. National Center for Tumor Diseases, Heidelberg, Germany. 20. Helios Klinikum Berlin-Buch, Klinik für Gynäkologie und Geburtshilfe, Berlin, Germany. 21. Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany. 22. National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany. 23. Department for Gynecology and Obstetrics, Interdisciplinary Breast Center, Esslingen, Germany.
Abstract
BACKGROUND: The impact of locoregional radiotherapy (RT) after neoadjuvant chemotherapy (NACT) and mastectomy in breast cancer patients is currently unclear. Several publications have suggested that patients with a favorable response to NACT might not benefit from RT after mastectomy. METHODS: A retrospective analysis of three prospective randomized NACT trials was performed. Information on the use of RT was available for 817 breast cancer patients with non-inflammatory breast cancer who underwent mastectomy after NACT within the GeparTrio, GeparQuattro, and GeparQuinto-trials. RT was administered to 676 of these patients (82.7%). RESULTS: The 5-year cumulative incidence of locoregional recurrence (LRR) was 15.2% (95% confidence interval [CI] 9.0-22.8%) in patients treated without RT and 11.3% in patients treated with RT (95% CI 8.7-14.3%). In the multivariate analysis, RT was associated with a lower risk of LRR (hazard ratio 0.51, 95% CI 0.27-1.0; p = 0.05). This effect was shown especially in patients with cT3/4 tumors, as well as in patients who were cN+ before neoadjuvant therapy, including those who converted to ypN0 after neoadjuvant therapy. In the bivariate analysis, disease-free survival was significantly worse in patients who received RT, however this was not confirmed in the multivariate analysis. CONCLUSIONS: Our results suggest that RT reduces the LRR rates in breast cancer patients who receive a mastectomy after NACT without an improvement in DFS. Prospective randomized controlled trials such as the National Surgical Adjuvant Breast and Bowel Project B-51/RTOG 1304 trial will analyze whether RT has any benefit in patients who have a favorable response after NACT.
RCT Entities:
BACKGROUND: The impact of locoregional radiotherapy (RT) after neoadjuvant chemotherapy (NACT) and mastectomy in breast cancerpatients is currently unclear. Several publications have suggested that patients with a favorable response to NACT might not benefit from RT after mastectomy. METHODS: A retrospective analysis of three prospective randomized NACT trials was performed. Information on the use of RT was available for 817 breast cancerpatients with non-inflammatory breast cancer who underwent mastectomy after NACT within the GeparTrio, GeparQuattro, and GeparQuinto-trials. RT was administered to 676 of these patients (82.7%). RESULTS: The 5-year cumulative incidence of locoregional recurrence (LRR) was 15.2% (95% confidence interval [CI] 9.0-22.8%) in patients treated without RT and 11.3% in patients treated with RT (95% CI 8.7-14.3%). In the multivariate analysis, RT was associated with a lower risk of LRR (hazard ratio 0.51, 95% CI 0.27-1.0; p = 0.05). This effect was shown especially in patients with cT3/4 tumors, as well as in patients who were cN+ before neoadjuvant therapy, including those who converted to ypN0 after neoadjuvant therapy. In the bivariate analysis, disease-free survival was significantly worse in patients who received RT, however this was not confirmed in the multivariate analysis. CONCLUSIONS: Our results suggest that RT reduces the LRR rates in breast cancerpatients who receive a mastectomy after NACT without an improvement in DFS. Prospective randomized controlled trials such as the National Surgical Adjuvant Breast and Bowel Project B-51/RTOG 1304 trial will analyze whether RT has any benefit in patients who have a favorable response after NACT.
Authors: Raymond B Mailhot Vega; Shu Wang; Eric D Brooks; Oluwadamilola T Oladeru; Natalie A Lockney; Lisa E Spiguel; Shannon M MacDonald; Eleftherios P Mamounas; Nancy P Mendenhall; Paul G Okunieff; Ji-Hyun Lee; Julie A Bradley Journal: Int J Radiat Oncol Biol Phys Date: 2022-03-29 Impact factor: 8.013