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Title: Local-Regional Recurrence With and Without Radiation Therapy After Neoadjuvant Chemotherapy and Mastectomy for Clinically Staged T3N0 Breast Cancer

Abstract

Purpose: The purpose of this study was to determine local-regional recurrence (LRR) risk according to whether postmastectomy radiation therapy (PMRT) was used to treat breast cancer patients with clinical T3N0 disease who received neoadjuvant chemotherapy (NAC) and mastectomy. Methodsand Materials: Clinicopathology data from 162 patients with clinical T3N0 breast cancer who received NAC and underwent mastectomy were retrospectively reviewed. A total of 119 patients received PMRT, and 43 patients did not. The median number of axillary lymph nodes (LNs) dissected was 15. Actuarial rates were calculated using the Kaplan-Meier method and compared using the log-rank test. Results: At a median follow-up of 75 months, 15 of 162 patients developed LRR. For all patients, the 5-year LRR rate was 9% (95% confidence interval [CI], 4%-14%). The 5-year LRR rate for those who received PMRT was 4% (95% CI, 1%-9%) vs. 24% (95% CI, 10%-39%) for those who did not receive PMRT (p <0.001). A significantly higher proportion of irradiated patients had pathology involved LNs and were {<=}40 years old. Among patients who had pathology involved LNs, the LRR rate was lower in those who received PMRT (p <0.001). A similar trend was observed for those who did not have pathology involvedmore » LN disease. Among nonirradiated patients, the appearance of pathologic LN disease after NAC was the only clinicopathologic factor examined that significantly correlated with the risk of LRR. Conclusions: Breast cancer patients with clinical T3N0 disease treated with NAC and mastectomy but without PMRT had a significant risk of LRR, even when there was no pathologic evidence of LN involvement present after NAC. PMRT was effective in reducing the LRR rate. We suggest PMRT should be considered for patients with clinical T3N0 disease.« less

Authors:
 [1];  [2]; ; ; ; ;  [1];  [3];  [2];  [1];  [1]
  1. Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States)
  2. Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States)
  3. Department of Breast Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States)
Publication Date:
OSTI Identifier:
21590453
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 81; Journal Issue: 3; Other Information: DOI: 10.1016/j.ijrobp.2010.06.027; PII: S0360-3016(10)00876-X; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEMOTHERAPY; HAZARDS; LYMPH NODES; MAMMARY GLANDS; NEOPLASMS; PATHOLOGY; RADIOTHERAPY; BODY; DISEASES; GLANDS; LYMPHATIC SYSTEM; MEDICINE; NUCLEAR MEDICINE; ORGANS; RADIOLOGY; THERAPY

Citation Formats

Nagar, Himanshu, Mittendorf, Elizabeth A., Strom, Eric A., Perkins, George H., Oh, Julia L., Tereffe, Welela, Woodward, Wendy A., Gonzalez-Angulo, Ana M., Hunt, Kelly K., Buchholz, Thomas A., and Yu, Tse-Kuan, E-mail: tkyu@mdanderson.org. Local-Regional Recurrence With and Without Radiation Therapy After Neoadjuvant Chemotherapy and Mastectomy for Clinically Staged T3N0 Breast Cancer. United States: N. p., 2011. Web. doi:10.1016/j.ijrobp.2010.06.027.
Nagar, Himanshu, Mittendorf, Elizabeth A., Strom, Eric A., Perkins, George H., Oh, Julia L., Tereffe, Welela, Woodward, Wendy A., Gonzalez-Angulo, Ana M., Hunt, Kelly K., Buchholz, Thomas A., & Yu, Tse-Kuan, E-mail: tkyu@mdanderson.org. Local-Regional Recurrence With and Without Radiation Therapy After Neoadjuvant Chemotherapy and Mastectomy for Clinically Staged T3N0 Breast Cancer. United States. doi:10.1016/j.ijrobp.2010.06.027.
Nagar, Himanshu, Mittendorf, Elizabeth A., Strom, Eric A., Perkins, George H., Oh, Julia L., Tereffe, Welela, Woodward, Wendy A., Gonzalez-Angulo, Ana M., Hunt, Kelly K., Buchholz, Thomas A., and Yu, Tse-Kuan, E-mail: tkyu@mdanderson.org. Tue . "Local-Regional Recurrence With and Without Radiation Therapy After Neoadjuvant Chemotherapy and Mastectomy for Clinically Staged T3N0 Breast Cancer". United States. doi:10.1016/j.ijrobp.2010.06.027.
@article{osti_21590453,
title = {Local-Regional Recurrence With and Without Radiation Therapy After Neoadjuvant Chemotherapy and Mastectomy for Clinically Staged T3N0 Breast Cancer},
author = {Nagar, Himanshu and Mittendorf, Elizabeth A. and Strom, Eric A. and Perkins, George H. and Oh, Julia L. and Tereffe, Welela and Woodward, Wendy A. and Gonzalez-Angulo, Ana M. and Hunt, Kelly K. and Buchholz, Thomas A. and Yu, Tse-Kuan, E-mail: tkyu@mdanderson.org},
abstractNote = {Purpose: The purpose of this study was to determine local-regional recurrence (LRR) risk according to whether postmastectomy radiation therapy (PMRT) was used to treat breast cancer patients with clinical T3N0 disease who received neoadjuvant chemotherapy (NAC) and mastectomy. Methodsand Materials: Clinicopathology data from 162 patients with clinical T3N0 breast cancer who received NAC and underwent mastectomy were retrospectively reviewed. A total of 119 patients received PMRT, and 43 patients did not. The median number of axillary lymph nodes (LNs) dissected was 15. Actuarial rates were calculated using the Kaplan-Meier method and compared using the log-rank test. Results: At a median follow-up of 75 months, 15 of 162 patients developed LRR. For all patients, the 5-year LRR rate was 9% (95% confidence interval [CI], 4%-14%). The 5-year LRR rate for those who received PMRT was 4% (95% CI, 1%-9%) vs. 24% (95% CI, 10%-39%) for those who did not receive PMRT (p <0.001). A significantly higher proportion of irradiated patients had pathology involved LNs and were {<=}40 years old. Among patients who had pathology involved LNs, the LRR rate was lower in those who received PMRT (p <0.001). A similar trend was observed for those who did not have pathology involved LN disease. Among nonirradiated patients, the appearance of pathologic LN disease after NAC was the only clinicopathologic factor examined that significantly correlated with the risk of LRR. Conclusions: Breast cancer patients with clinical T3N0 disease treated with NAC and mastectomy but without PMRT had a significant risk of LRR, even when there was no pathologic evidence of LN involvement present after NAC. PMRT was effective in reducing the LRR rate. We suggest PMRT should be considered for patients with clinical T3N0 disease.},
doi = {10.1016/j.ijrobp.2010.06.027},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 3,
volume = 81,
place = {United States},
year = {Tue Nov 01 00:00:00 EDT 2011},
month = {Tue Nov 01 00:00:00 EDT 2011}
}