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Does internal mammary node irradiation affect treatment outcome in clinical stage II-III breast cancer patients receiving neoadjuv ant chemotherapy?

 Kyung Hwan Kim  ;  Jae Myoung Noh  ;  Yong Bae Kim  ;  Jee Suk Chang  ;  Ki Chang Keum  ;  Seung Jae Huh  ;  Doo Ho Choi  ;  Won Park  ;  Chang-Ok Suh 
 BREAST CANCER RESEARCH AND TREATMENT, Vol.152(3) : 589-599, 2015 
Journal Title
Issue Date
Adult ; Animals ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Breast Neoplasms/drug therapy* ; Breast Neoplasms/mortality ; Breast Neoplasms/pathology ; Breast Neoplasms/radiotherapy* ; Disease-Free Survival ; Female ; Humans ; Lymph Nodes/radiation effects ; Lymphatic Metastasis ; Mastectomy ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local ; Survival Analysis ; Treatment Outcome
Internal mammary node irradiation ; Neoadjuvant chemotherapy ; Breast cancer
The purpose of this study is to assess the value of internal mammary node irradiation (IMNI) in patients receiving postoperative radiotherapy after neoadjuvant chemotherapy (NAC) using modern systemic therapy. Between 2001 and 2009, 521 consecutive patients with clinical stage II-III breast cancer received NAC and postoperative radiotherapy. With a consistent policy, the treating radiation oncologist either included (N = 284) or excluded (N = 237) the internal mammary node in the treatment volume. Anthracycline- and taxane-based chemotherapy was provided to 482 (92.5 %) patients. To account for the unbalanced characteristics between the two groups, we performed propensity score matching and covariate adjustment using the propensity score. The median follow-up duration was 71 months (range 31-153 months). The 5-year disease-free survival (DFS) with and without IMNI was 81.8 and 72.7 %, respectively (p = 0.019). The benefit of IMNI varied according to patient characteristics such that it was more apparent in patients with N1-2 disease, inner/central location, and triple-negative subtype. After adjusting for all potential confounding variables, IMNI was independently associated with improved DFS (p = 0.049). The significant effect of IMNI on DFS was sustained after propensity score matching (p = 0.040) and covariate adjustment using the propensity score (p = 0.048). Symptomatic radiation pneumonitis developed in 9 (3.2 %) patients receiving IMNI. Our results indicated that IMNI was associated with a significant improvement in DFS with low toxicity rate for breast cancer patients receiving NAC. Further prospective studies are warranted to confirm the effect of IMNI in the NAC setting.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Suh, Chang Ok(서창옥)
Chang, Jee Suk Paul(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
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