Format

Send to

Choose Destination
Breast Cancer Res. 2017 Jun 30;19(1):75. doi: 10.1186/s13058-017-0870-1.

Neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival.

Author information

1
Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, SRB 4, Tampa, FL, 33612, USA. jpoleszczuk@ibib.waw.pl.
2
Department for Mathematical Modeling of Physiological Processes, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland. jpoleszczuk@ibib.waw.pl.
3
Department of Cancer Imaging & Metabolism, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA.
4
Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA.
5
Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA.
6
Department of Breast Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA.
7
Department of Women's Oncology and Experimental Therapeutics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA.
8
Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, SRB 4, Tampa, FL, 33612, USA. heiko.enderling@moffitt.org.
9
Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA. heiko.enderling@moffitt.org.

Abstract

BACKGROUND:

Compared with surgery alone, postoperative adjuvant radiotherapy (RT) improves relapse-free survival of patients with early-stage breast cancer. We evaluated the long-term overall and disease-free survival rates of neoadjuvant (presurgical) versus adjuvant RT in early-stage breast cancer patients.

METHODS:

We used the Surveillance, Epidemiology, and End Results (SEER) database provided by the National Institutes of Health to derive an analytic dataset of 250,195 female patients with early-stage breast cancer who received RT before (n = 2554; 1.02%) or after (n = 247,641; 98.98%) surgery. Disease-free survival, defined as time to diagnosis of a second primary tumor at any location, was calculated from automated patient identification matching of all SEER records.

RESULTS:

Partial and complete mastectomies were performed in 94.4% and 5.6% of patients, respectively. In the largest cohort of estrogen receptor-positive women who underwent partial mastectomy, the HR of developing a second primary tumor after neoadjuvant compared with adjuvant RT was 0.64 (95% CI 0.55-0.75; P < 0.0001). Overall survival was independent of radiation sequence (HR 1; P = 0.95). Neoadjuvant RT also resulted in a lower HR for second primary cancer among estrogen receptor-positive patients who underwent mastectomy compared with those who received adjuvant RT (HR 0.48, 95% CI 0.26-0.87; P = 0.0162).

CONCLUSIONS:

Neoadjuvant RT may significantly improve disease-free survival without reducing overall survival, especially for estrogen receptor-positive patients with early-stage breast cancer. This finding warrants further exploration of potential long-term benefits of neoadjuvant radiotherapy for early-stage breast cancer in a controlled, prospective clinical trial setting, with correlative studies done to identify potential mechanisms of superiority.

KEYWORDS:

Disease-free survival; Early-stage breast cancer; Immune response; Overall survival; Postoperative radiotherapy; Preoperative radiotherapy

PMID:
28666457
PMCID:
PMC5493088
DOI:
10.1186/s13058-017-0870-1
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center