Does failure to achieve pathologic complete response with neoadjuvant chemotherapy identify node-negative patients who would benefit from postmastectomy radiation or regional nodal irradiation? Journal Article
| Authors: | Crown, A.; Gonen, M.; Le, T.; Morrow, M. |
| Article Title: | Does failure to achieve pathologic complete response with neoadjuvant chemotherapy identify node-negative patients who would benefit from postmastectomy radiation or regional nodal irradiation? |
| Abstract: | Background: Postmastectomy radiation (PMRT) and regional nodal irradiation (RNI) improve outcomes for patients at high risk of locoregional recurrence (LRR). Node-negative patients with the triple-negative (TN) subtype and those who do not have a pCR with neoadjuvant chemotherapy (NAC) are at increased risk for LRR, but whether the absolute risk for LRR is high enough to justify PMRT/RNI is uncertain. Methods: Patients with cT1-T3N0 and pN0 disease treated with NAC who had residual disease in the breast were identified from a prospective database. Patients were eligible for the study if they had mastectomy or breast-conserving therapy with negative margins and whole-breast radiation. Those receiving PMRT or RNI were excluded. Actuarial rates were estimated using the cumulative incidence function. Results: The 227 patients in this study had a mean age was 51.4 ± 12.6 years, and 82 (36.1%) were TN. During a median follow-up period of 35 months, nine LRR events occurred. The overall crude and actuarial 3-year LRR rates were 4.4% and 5.9%, respectively. The crude LRR rate for the TN patients was 7.4%, and the 3-year actuarial rate was 10.1%. The hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2−) patients had a crude LRR rate of 2.8% and a 3-year actuarial rate of 3.2%. The HER2+ patients had a crude LRR rate of 2.7% and a 3-year actuarial rate of 3.3%. Conclusions: Locoregional recurrence is uncommon for patients with node-negative HR+/HER2− and HER2+ tumors who have residual disease in the breast; however, TN patients have LRR rates that approach 10% at 3 years, suggesting a possible role for PMRT/RNI for node-negative TN patients. Additional follow-up with more patients is needed for definitive conclusions. © 2020, Society of Surgical Oncology. |
| Keywords: | adult; controlled study; aged; middle aged; major clinical study; cancer recurrence; capecitabine; paclitaxel; cancer radiotherapy; follow up; carboplatin; breast cancer; mastectomy; aromatase inhibitor; cohort analysis; minimal residual disease; tamoxifen; neoadjuvant chemotherapy; trastuzumab; anthracycline; lymph node irradiation; pertuzumab; triple negative breast cancer; trastuzumab emtansine; estrogen receptor positive breast cancer; human epidermal growth factor receptor 2 positive breast cancer; human; female; article; progesterone receptor positive breast cancer; breast radiotherapy; human epidermal growth factor receptor 2 negative breast cancer |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 28 |
| Issue: | 3 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2021-03-01 |
| Start Page: | 1328 |
| End Page: | 1335 |
| Language: | English |
| DOI: | 10.1245/s10434-020-09136-8 |
| PUBMED: | 32959140 |
| PROVIDER: | scopus |
| PMCID: | PMC7897220 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 April 2021 -- Source: Scopus |
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