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Ann Surg Oncol. 2019 Nov;26(12):3892-3901. doi: 10.1245/s10434-019-07635-x. Epub 2019 Jul 26.

Post-Mastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer: A Pooled Retrospective Analysis of Three Prospective Randomized Trials.

Author information

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.

PMID:
31350646
DOI:
10.1245/s10434-019-07635-x

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