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Role of Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer Patients: A Study from the Japanese Breast Cancer Registry

Journal Article · · Annals of Surgical Oncology (Online)
 [1];  [2];  [3];  [4];  [5];  [6];  [7];  [8];  [9];  [1];  [10];  [11];  [12];  [13];  [14];  [15];  [16];  [2]
  1. Tohoku University School of Medicine, Department of Breast and Endocrine Surgical Oncology (Japan)
  2. Tokai University School of Medicine, Department of Breast and Endocrine Surgery (Japan)
  3. The University of Tokyo, Department of Healthcare Quality Assessment, Graduate School of Medicine (Japan)
  4. Keio University, Department of Health Policy and Management School of Medicine (Japan)
  5. Okayama University Hospital, Department of Breast and Endocrine Surgery (Japan)
  6. Miyagi Cancer Center, Department of Breast Surgery (Japan)
  7. Kitakyushu Municipal Medical Center, Department of Surgery (Japan)
  8. St. Luke’s International Hospital, Department of Breast Surgical Oncology (Japan)
  9. Shikoku Cancer Center, Department of Breast Surgery (Japan)
  10. Sapporo-Kotoni Breast Clinic (Japan)
  11. Juntendo University School of Medicine, Department of Breast Surgery (Japan)
  12. Nihon University School of Medicine, Department of Pathology (Japan)
  13. St. Marianna University School of Medicine, Division of Breast and Endocrine Surgery, Department of Surgery (Japan)
  14. National Cancer Center Hospital, Department of Breast Surgery (Japan)
  15. National Defense Medical College, Department of Basic Pathology (Japan)
  16. Showa University School of Medicine, Division of Breast Surgical Oncology, Department of Surgery (Japan)
+ Show Author Affiliations

Background: The role of postmastectomy radiotherapy (PMRT) in breast cancer patients receiving neoadjuvant chemotherapy (NAC) is controversial. We aimed to evaluate the effectiveness of radiotherapy in patients treated with NAC and mastectomy in the Japanese Breast Cancer Registry. Methods: We enrolled patients who received NAC and mastectomy for cT1–4 cN0–2 M0 breast cancer. We evaluated the association between radiotherapy and outcomes, locoregional recurrence (LRR), distant disease-free survival (DDFS), and overall survival (OS) based on ypN status by multivariable analysis. Results: Of the 145,530 patients, we identified 3226 who met the inclusion criteria. Among ypN1 patients, no differences were found in LRR, DDFS, or OS between groups with and without radiotherapy (p = 0.72, p = 0.29, and p = 0.36, respectively). Radiotherapy was associated with improved LRR-free survival (p < 0.001), DDFS (p = 0.01), and OS (p < 0.001) in patients with ypN2–3. Multivariable analysis demonstrated that use of radiotherapy was independently associated with improved LRR [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.45–0.82, p = 0.001] and OS [HR 0.69, 95% CI 0.53–0.89, p = 0.004) for ypN2–3 patients only. The association between radiotherapy and OS was not statistically significant among ypN0 (p = 0.22) and ypN1 patients (p = 0.51). Conclusions: The results from this nationwide database study did not show significant associations between PMRT and improved survival among ypN0 and ypN1 patients. Radiotherapy may be beneficial only for ypN2–3 breast cancer patients who receive NAC and mastectomy in the modern era.

OSTI ID:
22927644
Journal Information:
Annals of Surgical Oncology (Online), Journal Name: Annals of Surgical Oncology (Online) Journal Issue: 8 Vol. 26; ISSN 1534-4681
Country of Publication:
United States
Language:
English

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