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The role of postmastectomy radiation therapy after neoadjuvant chemotherapy in clinical stage II-III breast cancer patients with pN0: A multicenter, retrospective study (KROG 12-05)

Authors
 Su Jung Shim  ;  Won Park  ;  Seung Jae Huh  ;  Doo Ho Choi  ;  Kyung Hwan Shin  ;  Nam Kwon Lee  ;  Chang-Ok Suh  ;  Ki Chang Keum  ;  Yong Bae Kim  ;  Seung Do Ahn  ;  Su Ssan Kim  ;  Sung W. Ha  ;  Eui Kyu Chie  ;  Kyubo Kim  ;  Hyun Soo Shin  ;  Jin Hee Kim  ;  Hyung-Sik Lee 
Citation
 INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, Vol.88(1) : 65-72, 2014 
Journal Title
 INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 
ISSN
 0360-3016 
Issue Date
2014
MeSH
Adult ; Age Factors ; Aged ; Analysis of Variance ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Breast Neoplasms/drug therapy ; Breast Neoplasms/mortality ; Breast Neoplasms/pathology ; Breast Neoplasms/radiotherapy* ; Breast Neoplasms/surgery ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Female ; Humans ; Linear Models ; Lymph Node Excision ; Mastectomy/statistics & numerical data ; Middle Aged ; Neoadjuvant Therapy/methods ; Neoplasm Staging ; Regression Analysis ; Retrospective Studies
Abstract
PURPOSE: The purpose of this study was to investigate the role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) in clinical stage II-III breast cancer patients with pN0. METHODS AND MATERIALS:We retrospectively identified 417 clinical stage II-III breast cancer patients who achieved an ypN0 at surgery after receiving NAC between 1998 and 2009. Of these, 151 patients underwent mastectomy after NAC. The effect of PMRT on disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and overall survival (OS) was evaluated by multivariate analysis including known prognostic factors using the Kaplan-Meier method and compared using the log-rank test and Cox proportional regression analysis. RESULTS:Of the 151 patients who underwent mastectomy, 105 (69.5%) received PMRT and 46 patients (30.5%) did not. At a median follow-up of 59 months, 5 patients (3.3%) developed LRR (8 sites of recurrence) and 14 patients (9.3%) developed distant metastasis. The 5-year DFS, LRRFS, and OS rates were 91.2, 98.1, and 93.3% with PMRT and 83.0%, 92.3%, and 89.9% without PMRT, respectively (all P values not significant). By univariate analysis, only age (≤40 vs >40 years) was significantly associated with decreased DFS (P=.027). By multivariate analysis, age (≤40 vs >40 years) and pathologic T stage (0-is vs 1 vs 2-4) were significant prognostic factors affecting DFS (hazard ratio [HR] 0.353, 95% confidence interval [CI] 0.135-0.928, P=.035; HR 2.223, 95% CI 1.074-4.604, P=.031, respectively). PMRT showed no correlation with a difference in DFS, LRRFS, or OS by multivariate analysis. CONCLUSIONS:PMRT might not be necessary for pN0 patients after NAC, regardless of clinical stage. Prospective randomized clinical trial data are needed to assess whether PMRT can be safely omitted in pN0 patients after NAC and mastectomy for clinical stage II-III breast cancer.
Full Text
http://www.sciencedirect.com/science/article/pii/S0360301613031088
DOI
10.1016/j.ijrobp.2013.09.021
Appears in Collections:
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)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99265
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