Impact of Postmastectomy Radiotherapy on Locoregional Control and Disease-Free Survival in Patients with Breast Cancer Treated with Neoadjuvant Chemotherapy

Overview

Journal J Oncol

Specialty Oncology

Date 2021 Feb 10

PMID 33564308

Citations 4

Authors

Yanyu Zhang

Yaotian Zhang

Zhuang Liu

Zilan Qin

Yubing Li

Jiaming Zhao

Xinchi Ma

QianKun Yang

Ning Han

Xue Zeng

Hong Guo

Na Zhang

Affiliations

Soon will be listed here.

Abstract

Background: The impact of postmastectomy radiotherapy (PMRT) in patients receiving neoadjuvant chemotherapy (NAC) is unclear. The purpose of this study is to identify the patients who may benefit from PMRT.

Methods: We retrospectively analysed patients with clinical stage II-III breast cancer who underwent NAC and modified radical mastectomy at our centre from 2007 to 2015. We investigated the relationship amongst locoregional recurrence rate (LRR), disease-free survival (DFS), and clinical pathological characters.

Results: A total of 554 patients were analysed in this study. The median follow-up time was 65 months. Amongst the patients, 58 (10.5%) had locoregional recurrence, 138 (24.9%) had distant metastasis, and 72 (13.0%) patients died. The 5-year cumulative incidence of LRR and DFS was 9.2% and 74.2%, respectively. A total of 399 (72%) patients received PMRT and 155 (28%) did not. The 5-year LRR of the patients with PMRT (7.3% vs. 14.1%, =0.01) decreased significantly. We found that PMRT was an independent prognostic factor of LRR and DFS. Patients with the persistent involvement of 1-3 lymph nodes (ypN1) and more than 4 positive lymph nodes (ypN2-3) had a better outcome after PMRT than those without. However, the LRR and DFS of patients with negative lymph nodes at the time of surgery (ypN0) and who received PMRT showed no significant benefits. Amongst all patients with the three molecular subtypes of breast cancer, patients with triple-negative breast cancer had the highest pathological complete response rate but the worst prognosis (=0.001).

Conclusion: Results showed that PMRT significantly reduced the LRR of patients with clinical stage II-III breast cancer after receiving NAC and mastectomy. YpN0 patients derived no local control or survival benefit after receiving PMRT, whereas those with ypN1 and ypN2-3 could obviously benefit from PMRT.

Citing Articles

Does Post-Mastectomy Radiotherapy Confer Survival Benefits on Patients With 1-3 Clinically Positive Lymph Nodes Rendered Pathologically Negative After Neoadjuvant Systemic Chemotherapy: Consensus from A Pooled Analysis?.

Alamoodi M Eur J Breast Health. 2024; 20(2):81-88.

PMID: 38571693 PMC: 10985578. DOI: 10.4274/ejbh.galenos.2024.2023-12-14.

Axillary response and outcome in breast cancer patients after neoadjuvant treatment: The role of radiotherapy in reducing recurrence in ypN0 patients with initially cN+ stage.

Ren X, Yu Y, Liu L, Xia W, Ni R, Wei S Front Oncol. 2023; 13:1093155.

PMID: 37077821 PMC: 10106717. DOI: 10.3389/fonc.2023.1093155.

Impact of Postmastectomy Radiation Therapy on Breast Cancer Patients According to Pathologic Nodal Status after Modern Neoadjuvant Chemotherapy.

Kim D, Kim J, Kim I, Chang J, Shin K Cancer Res Treat. 2022; 55(2):592-602.

PMID: 36228653 PMC: 10101778. DOI: 10.4143/crt.2022.998.

Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy in cTN Breast Cancer Patients: A Single Center Experience and Review of Current Literature.

Luo M, Chen H, Deng H, Jin Y, Wang G, Zhang K Front Oncol. 2022; 12:881047.

PMID: 35656513 PMC: 9152099. DOI: 10.3389/fonc.2022.881047.

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