Long-term outcome after neoadjuvant radiochemotherapy in locally advanced noninflammatory breast cancer and predictive factors for a pathologic complete remission: Results of a multivariate analysis.

Abstract

154 Background: An earlier published series of neoadjuvant radio-chemotherapy (NRT-CHX) in locally advanced noninflammatory breast cancer (LABC) has now been updated with a follow-up of more than 15 years. Long-term outcome data and predictive factors for pathologic complete response (PCR) were analyzed. Methods: 315 LABC patients (cT1-cT4 /cN0-N1) were treated during 1991-1998 with NRT-CHX. Preoperative radiotherapy (RT) consisted of external beam radiation therapy (EBRT) of 50 Gy (5 × 2 Gy/week) to the breast and the supra-/infraclavicular lymph nodes combined with an electron boost in 214 cases afterwards or—in case of breast conservation—a 10-Gy interstitial boost with 192Ir afterloading before EBRT. Chemotherapy was administered prior to RT in 192 patients, and concomitantly in 113; 10 patients received no chemotherapy. The update of all follow up ended in November 2011. Age, tumor grade, nodal status, hormone receptor status, simultaneous vs. sequential CHX and the time interval between end of RT and surgery were examined in multivariate terms with as endpoint pCR and overall survival. Results: The total PCR rate after neoadjuvant RT-CHX reached 29.2 % with LABC breast conservation becoming possible in 50.8%. In initially node-positive cases (cN+), a complete nodal response (pN0) after NRT-CHX was observed in 56% (89/159). The multivariate analysis revealed that a longer time interval to surgery increased the probability for a pCR (HR 1,17 [95% CI 1,05-1,31], p<0,01). However, in large tumors (T3-T4) a significantly reduced pCR rate (HR 0.89 [95% CI 0.80 to 0.99], p = 0.03) could be obtained. Importantly, a pCR was the strongest prognostic factor for long-term survival (HR 0.28 [95% CI 0.19-0.56], p<0.001). Conclusions: A PCR identifies patients with a significant better prognosis for long-term survival. However, a long time interval to surgery (> 2 months) increases the probability of a pCR after NRT-CHX.

Locally advanced breast cancer

“…The patients underwent mastectomy and axillary clearance 6 weeks later achieving a pathologic complete response rate in the breast of 15% and in axillary nodes of 7.5% [25]. Long-term follow up of a German series of 315 patients with LABC treated with neoadjuvant chemotherapy and radiotherapy reported better outcomes in patients with pCR and if the chemotherapy and radiotherapy were given concurrently [26]. Further, a randomized clinical trial from China comparing the sequencing of treatments for LABC indicated a possible benefit regarding both outcome and side effects with preoperative instead of postoperative radiotherapy [27].…”

Long-term results of combined and complex treatment of patients with locally advanced HER2-positive breast cancer

“…С другой стороны -может при-вести к развитию серьезных осложнений. В литературе к настоящему моменту представлены данные различных исследований по безопасности и эффективности как па-раллельного [4,5,6,7], так и последовательного приме-нения химиолучевой терапии [8,9,10]. Помимо этого, активно изучается радиочувствительность опухолей, обладающих гиперэкспрессией HER2 / neu [11].…”

IOERT as anticipated tumor bed boost during breast‐conserving surgery after neoadjuvant chemotherapy in locally advanced breast cancer—Results of a case series after 5‐year follow‐up

“…To date, reported pCR rates range between 15 and 51%, in dependency of the given chemotherapy regimens, additional administration of targeted therapies as well as the definition of pCR . In summary, it is concluded that the lower the tumor response on PST, the worse the clinical outcome …”

“…[18][19][20][21][22][23] In summary, it is concluded that the lower the tumor response on PST, the worse the clinical outcome. 21,24 Despite the tumor reductive effects of PST, the highest contribution for controlling remnant in-breast disease still comes from radiotherapy by WBI. 25 In addition, it is commonly accepted and well proven that further dose escalation to the tumor bed can lower ipsilateral breast tumor recurrence (IBTR) rates most effectively.…”