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Comparison of Breast Conserving Surgery Followed by Radiation Therapy with Mastectomy Alone for Pathologic N1 Breast Cancer Patients in the Era of Anthracycline Plus Taxane-Based Chemotherapy: A Multicenter Retrospective Study (KROG 1418)

 Gyu Sang Yoo  ;  Won Park  ;  Jeong Il Yu  ;  Doo Ho Choi  ;  Yeon-Joo Kim  ;  Kyung Hwan Shin  ;  Chan Woo Wee  ;  Kyubo Kim  ;  Kyung Ran Park  ;  Yong Bae Kim  ;  Sung Ja Ahn  ;  Jong Hoon Lee  ;  Jin Hee Kim  ;  Mison Chun  ;  Hyung-Sik Lee  ;  Jung Soo Kim  ;  Jihye Cha 
 CANCER RESEARCH AND TREATMENT, Vol.51(3) : 1041-1051, 2019-07 
Journal Title
Issue Date
Adult ; Anthracyclines / therapeutic use* ; Breast Neoplasms / pathology ; Breast Neoplasms / therapy* ; Female ; Humans ; Mastectomy / methods* ; Mastectomy, Segmental ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Propensity Score ; Radiotherapy, Adjuvant / methods* ; Retrospective Studies ; Survival Analysis ; Taxoids / therapeutic use* ; Treatment Outcome
Anthracyclines ; Breast conserving surgery ; Breast neoplasms ; Mastectomy ; Pathologic N1 ; Radiation Radiotherapy ; Taxane
Purpose: We compared the oncologic outcomes of breast-conserving surgery plus radiation therapy (BCS+RT) and modified radical mastectomy (MRM) under anthracycline plus taxane-based (AT) regimens and investigated the role of adjuvant radiation therapy (RT) in patients with pathologic N1 (pN1) breast cancer treated by mastectomy.

Materials and methods: We retrospectively reviewed the medical records of 2,011 patients with pN1 breast cancer who underwent BCS+RT or MRM alone at 12 institutions between January 2006 and December 2010. Two-to-one propensity score matching was performed for balances in variables between the groups.

Results: The median follow-up duration for the total cohort was 69 months (range, 1 to 114 months). After propensity score matching, 1,074 patients (676 in the BCS+RT group and 398 in the MRM-alone group) were analyzed finally. The overall survival, disease-free survival, locoregional failure-free survival, and regional failure-free survival (RFFS) curves of the BCS+RT group vs. MRM-alone group were not significantly different. The subgroup analysis revealed that in the group with both lymphovascular invasion (LVI) and histologic grade (HG) III, the BCS+RT showed significantly superior RFFS (p=0.008). Lymphedema (p=0.007) and radiation pneumonitis (p=0.031) occurred more frequently in the BCS+RT group than in the MRM-alone group, significantly.

Conclusion: There are no differences in oncologic outcomes between BCS+RT and MRM-alone groups under the AT chemotherapy regimens for pN1 breast cancer. However, BCS+RT group showed superior RFFS to MRM-alone group in the patients with LVI and HG III. Adjuvant RT might be considerable for pN1 breast cancer patients with LVI and HG III.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
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