Temporal Trends and Factors Associated with Receipt of Post-mastectomy Radiation After Neoadjuvant Chemotherapy in Women with CT3 Breast Cancer

Overview

Journal Ann Surg Oncol

Publisher Springer

Specialty Oncology

Date 2023 Jul 17

PMID 37460741

Authors

Ritika Manik

Connor B Grady

Leisha C Elmore

Jennifer H Fieber

Gary M Freedman

Rachel C Jankowitz

Julia C Tchou

Jennifer Q Zhang

Rebecca A Hubbard

Oluwadamilola M Fayanju

Affiliations

Soon will be listed here.

Abstract

Introduction: Given the potential impact of increasingly effective neoadjuvant chemotherapy (NACT) on post-mastectomy radiotherapy (PMRT) recommendations, we examined temporal trends in post-NACT PMRT for cT3 breast cancer.

Methods: We identified women ≥ 18 years in the National Cancer Database (NCDB) diagnosed 2004-2019 with cT3N0-1M0 breast cancer treated with chemotherapy and mastectomy. Multivariable logistic regression and Cox proportional hazards models were used to estimate associations between pathologic NACT response [complete response (CR), partial response (PR), or no response (NR); or disease progression (DP)] and PMRT and between PMRT and overall survival (OS), respectively.

Results: We identified 39,901 women (Asian/Pacific Islander 1731, Black 5875, Hispanic 3265, White 27,303). Among cN0 patients with CR, PMRT rates declined from 67% in 2004 to 35% in 2019 but remained unchanged for patients with DP. Relative to NR, CR [odds ratio (OR) 0.36, 95% confidence interval (CI) 0.29-0.46] and PR (OR 0.44, 95% CI 0.36-0.55) in cN0 patients were associated with lower odds of PMRT while DP (OR 1.33, 95% CI 1.05-1.69) was associated with higher odds. Among cN1 patients, PMRT rates decreased from 90% to 73% for CR between 2005 and 2019 and increased from 76% to 82% for DP between 2004 and 2019. Relative to NR, CR (OR 0.78, 95% CI 0.63-0.95) was associated with lower odds of PMRT while DP (OR 1.93, 95% CI 1.58-2.37) was associated with higher odds. PMRT was associated with improved OS among cN1 patients (hazard ratio (HR) 0.77, 95% CI 0.67-0.88).

Conclusion: CR was associated with decreased PMRT receipt over time, while temporal trends following PR and DP differed by cN status, suggesting that nodal involvement guided PMRT receipt more than in-breast disease.

Citing Articles

ASO Author Reflections: The Case for Using Response to Neoadjuvant Chemotherapy to Guide Administration of Post-mastectomy Radiation.

Manik R, Fayanju O Ann Surg Oncol. 2023; 30(11):6516-6517.

PMID: 37493891 PMC: 10825509. DOI: 10.1245/s10434-023-13923-4.

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