Effect of Postmastectomy Radiotherapy in Patients <35 Years Old With Stage II-III Breast Cancer Treated With Doxorubicin-Based Neoadjuvant Chemotherapy and Mastectomy

Abstract

Purpose-Postmastectomy radiotherapy (PMRT) improves locoregional control (LRC) in patients with high-risk features after mastectomy. Young age continues to evolve as a potentially important risk factor. The objective of this study was to assess the benefits of PMRT in patients <35 years old treated with doxorubicin-based neoadjuvant chemotherapy for Stage II-III breast cancer.Patients and Methods-We retrospectively analyzed 107 consecutive breast cancer patients <35 years old with Stage IIA-IIIC disease treated at our institution with doxorubicin-based neoadjuvant chemotherapy and mastectomy, with or without PMRT. The treatment groups were compared in terms of LRC and overall survival.Results-Despite more advanced disease stages, the patients who received PMRT (n = 80) had greater rates of LRC (5-year rate, 88% vs. 63%, p = 0.001) and better overall survival (5-year rate, 67% vs. 48%, p = 0.03) than patients who did not receive PMRT (n = 27).Conclusion-Among breast cancer patients <35 years old at diagnosis, the use of PMRT after doxorubicin-based neoadjuvant chemotherapy and mastectomy led to a statistically greater rate of LRC and overall survival compared with patients without PMRT. The benefit seen for PMRT in

Prognostic outcomes and decision-making for local-regional therapy after neoadjuvant chemotherapy: Pretreatment clinical staging or posttreatment pathologic staging?

“…Those stage II patients who presented with clinical T1 or T2 lesions or who had one to three positive lymph nodes after chemotherapy were found to have a lower risk for LRR [33]. Patients younger than 35 who presented with stage IIB to stage III disease and who underwent anthracycline-based neoadjuvant chemotherapy and postmastectomy radiation therapy demonstrated improved local-regional control and overall survival compared with patients who did not receive postmastectomy radiation therapy [34]. Management questions remain for stage II patients who are found to be node negative at fi nal pathology and for patients with one to three positive ALNs.…”

Post-mastectomy radiotherapy after neodjuvant chemotherapy in breast cancer patients: A review

“…Table 1 lists the main variables identified in the literature on post-NAC PMRT [1][2][3][12][13][14][19][20][21][22][23][24][25][26][27][28]. There are a high number of host-, disease-and treatment-related parameters shown to reach statistically significant levels and, in terms of treatment outcome, their relevance quite markedly vary among the reports, even for those published in a recent past.…”

“…Classes and types of risk factors Buchholz [1,2] Huang [8,9] Garg [19,20] Truong [21,22] McGuire [14] Nagar [23] Mamounas [1] Fowble [24] Allis [25] Wright [26] Moo [27] Shim [28] Clinical In the combined analysis of these two NAC trials, patients who achieved a pCR continue to have significantly superior DFS and OS outcomes compared with patients who did not. In the 1071 patients treated by mastectomy, the 10-year cumulative incidence of LRR was 12.3% for mastectomy patients: 8.9% of them were local, 3.4% regional.…”

Radiation Oncology

“…Retrospective studies report a greater than 20% risk of locoregional failure in patients with clinical stage III cancer who achieve a pathologic complete remission. 7,9,[83][84][85] Alternatively, patients with clinical stage II disease and pathologic complete remission have locoregional failure of less than 10% and thus may not benefi t from PMXRT. Given the limited data, it may be prudent to offer PMXRT to any patient with residual nodal disease after neoadjuvant chemotherapy and to patients presenting with stage III disease, regardless of their pathologic response.…”