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Clin Breast Cancer. 2019 Feb;19(1):78-86. doi: 10.1016/j.clbc.2018.08.009. Epub 2018 Aug 28.

Role of Elective Nodal Irradiation in Patients With ypN0 After Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery (KROG 16-16).

Author information

1
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 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, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
4
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
5
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
6
Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Korea.
7
Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
8
Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea.
9
Department of Radiation Oncology, Chonbuk National University Medical School, Jeonju, Korea.
10
Department of Radiation Oncology, Inha University Hospital, Incheon, Korea.
11
Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Radiation Oncology, Konyang University College of Medicine, Daejeon, Korea.
12
Department of Radiation Oncology, Chungnam National University College of Medicine, Daejeon, Korea.
13
Department of Radiation Oncology, Inje University Busan Paik Hospital, Busan, Korea.

Abstract

BACKGROUND:

Given the lack of established indications for elective nodal irradiation (ENI) in ypN0 patients after neoadjuvant chemotherapy (NAC) and breast-conserving surgery (BCS), we set out to investigate the role of ENI in ypN0 patients according to subtype and pathologic complete remission (pCR) status.

PATIENTS AND METHODS:

We analyzed 261 patients who received NAC followed by BCS and adjuvant radiotherapy in 13 institutions of the Korean Radiation Oncology Group from 2005 to 2011. The tumors were classified into one of 3 subtypes: luminal (estrogen receptor positive or progesterone receptor positive and HER2 negative), HER2 (HER2 positive), or triple negative (estrogen receptor, progesterone receptor, and HER2 negative). We compared locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) according to ENI in different subgroups generated by the subtype and pCR statuses.

RESULTS:

In all patients, the 5-year LRC, DFS, and OS rates were 96.0%, 91.0%, and 96.8%, respectively. In all patients, axillary lymph node dissection was found to be the only favorable factor for LRC (P = .023) and DFS (P = .001). Age ≥ 50 years (P = .027), negative resection margin (P = .002), and axillary lymph node dissection (P = .002) were all favorable factors for OS. ENI did not affect LRC, DFS, or OS. Subgroup analysis by tumor subtype and pCR showed that ENI was not associated with greater LRC or DFS in any subgroups.

CONCLUSION:

In ypN0 patients after NAC and BCS, ENI did not improve LRC or survival, regardless of subtype or primary tumor response. This result should be verified through larger prospective trials.

KEYWORDS:

Breast neoplasm; Neoadjuvant therapy; Partial mastectomy; Radiation therapy; Subtype

PMID:
30241965
DOI:
10.1016/j.clbc.2018.08.009

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