Concurrent Neoadjuvant Chemotherapy and Radiation Therapy in Locally Advanced Breast Cancer

Brackstone, Muriel; Palma, David A.; Tuck, Alan B.; Scott, Leslie A.; Potvin, Kylea; Vandenberg, Theodore A.; Perera, Francisco; D’Souza, David; Taves, Donald H.; Kornecki, Anat; Muscedere, Giulio; Chambers, Ann F.

doi:10.1016/j.ijrobp.2017.06.005

Cited by 54 publications

(47 citation statements)

References 34 publications

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“…3 Over the last decade, the prognosis of advanced breast cancer, such as stage IIIC, has improved as a result of the development of multimodality treatment (including neoadjuvant chemotherapy (NAC), radical surgery, adjuvant chemotherapy, radiotherapy, endocrine therapy, and target therapy). [4][5][6] According to previous studies, the 5-year DFS and OS rates of N3a, N3b and N3c were approximately 43-66% and 58-81%, [7][8][9][10][11][12] 56-90% and 71-80%, [13][14][15][16][17][18] and 25-51% and 33-78%, [17][18][19][20][21][22][23] respectively. However, the clinical outcomes under current standard systemic management in a large consecutive sample of N3 breast cancer cases remain unclear to date, and comparative studies on the N3 subgroup are also scarce.…”

Section: Introductionmentioning

confidence: 84%

<p>Clinical Outcomes of N3 Breast Cancer: A Real-World Study of a Single Institution and the US Surveillance, Epidemiology, and End Results (SEER) Database</p>

Liao

et al. 2020

CMAR

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Background: Although stage IIIC (any TN3M0) breast cancer is known to have a dismal prognosis, the clinical outcome of current standard management and the prognostic differences between N3a, N3b and N3c remain to be further investigated. Material and Methods: Data from our center on pathologic N3 (pN3) (n=284) breast cancer and the US Surveillance, Epidemiology, and End Results (SEER) database on clinical N3 (cN3) (n=15,291) and M1 (n=23,623) breast cancer between January 2004 and December 2015 were systematically analyzed for clinicopathological characteristics and survival outcomes. Results: In our institution, patients with pN3c had the worst survival, with 5-year OS and DFS rates of 52.4% and 41.5%, respectively. Patients with pN3b had a relatively good prognosis, with a 5-year OS rate of 75.3% vs 63.9% for the pN3a group (p=0.045). For DFS, the 5-year survival rate was 63.1% in the pN3b group compared with 40.3% in the pN3a group (p=0.030). In the US SEER database, patients with cN3c had the worst survival in the cN3 group, but the prognosis of cN3c was much better than that of M1. Similarly, patients with cN3b had a better prognosis compared with patients in other groups, with a 5-year OS rate of 68.9% vs 61.9% for the cN3a group (p<0.001) and a 5-year BCSS rate of 73.4% vs 67.1% for the cN3a group (p<0.001). Conclusion: Breast cancer patients with N3c had the worst clinical outcomes, while the prognosis of N3b patients was better than that of N3a patients.

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Section: Introductionmentioning

confidence: 84%

<p>Clinical Outcomes of N3 Breast Cancer: A Real-World Study of a Single Institution and the US Surveillance, Epidemiology, and End Results (SEER) Database</p>

Liao

et al. 2020

CMAR

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“…Concurrent radiosensitizing chemotherapy and RT have demonstrated favorable local disease response in locally advanced breast cancer in the upfront setting and in patients whose disease is resistant to firstline chemotherapy. [29][30][31] Likewise, hyperthermia is a well-known radiosensitizer, and its combination with RT has demonstrated improved local control compared with RT alone in randomized studies, 32,33 with acceptable toxicity profiles. 34 Therefore, treatment with concurrent radiosensitizing chemotherapy or hyperthermia should also be considered in future prospective trials for patients with TNBC who have residual LVSI and/or ENE after NAC.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Locoregional Recurrence After Failure to Achieve Pathologic Complete Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

Gabani

Merfeld

Srivastava

et al. 2019

Journal of the National Comprehensive Cancer Network

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Background: This study evaluated factors predictive of locoregional recurrence (LRR) in women with triple-negative breast cancer (TNBC) treated with neoadjuvant chemotherapy who do not experience pathologic complete response (pCR). Methods: This is a single-institution retrospective review of women with TNBC treated with neoadjuvant chemotherapy, surgery, and radiation therapy in 2000 through 2013. LRR was estimated between patients with and without pCR using the Kaplan-Meier method. Patient-, tumor-, and treatment-specific factors in patients without pCR were analyzed using the Cox proportional hazards method to evaluate factors predictive of LRR. Log-rank statistics were then used to compare LRR among these risk factors. Results: A total of 153 patients with a median follow-up of 48.6 months were included. The 4-year overall survival and LRR were 70% and 15%, respectively, and the 4-year LRR in patients with pCR was 0% versus 22.0% in those without (P<.001). In patients without pCR, lymphovascular space invasion (LVSI; hazard ratio, 3.92; 95% CI, 1.64–9.38; P=.002) and extranodal extension (ENE; hazard ratio, 3.32; 95% CI, 1.35–8.15; P=.009) were significant predictors of LRR in multivariable analysis. In these patients, the 4-year LRR with LVSI was 39.8% versus 15.0% without (P<.001). Similarly, the 4-year LRR was 48.1% with ENE versus 16.1% without (P=.002). In patients without pCR, the presence of both LVSI and ENE were associated with an even further increased risk of LRR compared with patients with either LVSI or ENE alone and those with neither LVSI nor ENE in the residual tumor (P<.001). Conclusions: In patients without pCR, the presence of LVSI and ENE increases the risk of LRR in TNBC. The risk of LRR is compounded when both LVSI and ENE are present in the same patient. Future clinical trials are warranted to lower the risk of LRR in these high-risk patients.

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“…However, approximately 20%‐25% patients are diagnosed with locally advanced breast cancer, and these patients account for early relapse and deaths . A large number of studies have proved that surgery combined with adjuvant chemotherapy and radiotherapy can effectively improve the survival rate of patients according to the progress of early detection and treatment …”

Section: Introductionmentioning

confidence: 99%

Pre‐treatment systemic immune‐inflammation index is a useful prognostic indicator in patients with breast cancer undergoing neoadjuvant chemotherapy

Chen

Kong

Wang

et al. 2020

J Cellular Molecular Medi

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The systemic immune‐inflammation index (SII = N × P/L) based on neutrophil (N), platelet (P) and lymphocyte (L) counts is used to predict the survival of patients with malignant tumours and can fully reflect the balance between host inflammatory and immune status. This study is conducted to explore the potential prognostic significance of SII in patients with breast cancer undergoing neoadjuvant chemotherapy (NACT). A total of 262 patients with breast cancer received NACT were enrolled in this study. According to the receiver operating characteristic curve, the optimal cut‐off value of SII was divided into two groups: low SII group (<602 × 109/L) and high SII group (≥602 × 109/L). The associations between breast cancer and clinicopathological variables by SII were determined by chi‐squared test or Fisher's exact test. The Kaplan‐Meier plots and log‐rank test were used to determine clinical outcomes of disease‐free survival (DFS) and overall survival (OS). The prognostic value of SII was analysed by univariate and multivariate Cox proportional hazards regression models. The toxicity of NACT was accessed by National Cancer Institute Common Toxicity Criteria (NCICTC). According to univariate and multivariate Cox regression survival analyses, the results showed that the value of SII had prognostic significance for DFS and OS. The patients with low SII value had longer DFS and OS than those with high SII value (31.11 vs 40.76 months, HR: 1.075, 95% CI: 0.718‐1.610, P = .006; 44.47 vs 53.68 months, HR: 1.051, 95% CI: 0.707‐1.564, P = .005, respectively). The incidence of DFS and OS in breast cancer patients with low SII value was higher than that in those patients with high SII value in 3‐, 5‐ and 10‐year rates. The common toxicities after NACT were haematological and gastrointestinal reaction, and there were no differences by SII for the assessment of side effects of neoadjuvant chemotherapy. Meanwhile, the results also proved that breast cancer patients with low SII value and high Miller and Payne grade (MPG) survived longer than those breast cancer with high SII value and low MPG grade. In patients without lymph vessel invasion, these breast cancer patients with low SII value had better prognosis and lower recurrence rates than those with high SII value. Pre‐treatment SII with the advantage of reproducible, convenient and non‐invasive was a useful prognostic indicator for breast cancer patients undergoing neoadjuvant chemotherapy and is a promising biomarker for breast cancer on treatment strategy decisions.

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Concurrent Neoadjuvant Chemotherapy and Radiation Therapy in Locally Advanced Breast Cancer

Cited by 54 publications

References 34 publications

<p>Clinical Outcomes of N3 Breast Cancer: A Real-World Study of a Single Institution and the US Surveillance, Epidemiology, and End Results (SEER) Database</p>

<p>Clinical Outcomes of N3 Breast Cancer: A Real-World Study of a Single Institution and the US Surveillance, Epidemiology, and End Results (SEER) Database</p>

Predictors of Locoregional Recurrence After Failure to Achieve Pathologic Complete Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

Pre‐treatment systemic immune‐inflammation index is a useful prognostic indicator in patients with breast cancer undergoing neoadjuvant chemotherapy

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