Neoadjuvant chemotherapy and radiotherapy for locally advanced breast cancer: Safety and efficacy of reverse sequence compared to standard technique?

Mairé, Mathilde; Debled, Marc; Petit, A.; Fournier, Marion; MacGrogan, Gaëtan; Quenel-Thueux, Nathalie; Charitansky, H.; Mathoulin‐Pélissier, Simone; Bonnefoi, Hervé; Lara, C. Tunon de

doi:10.1016/j.ejso.2022.04.022

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…With a shortage of evidence from randomized studies, the gain in pCR rate driven by naRT can only be indirectly deduced from published works. A retrospective single-center comparison reported a numerically higher pCR rate in the patients treated with naRT and naCT compared to the standard sequence (naCT followed by surgery and RT) of 39% vs. 18% in the standard sequence, with especially high rates of pCR in the triple-negative cohort (78% vs. 27.6%) [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Long-Term Survival after Neoadjuvant Radiotherapy and Chemotherapy in High-Risk Breast Cancer

Haussmann

Budach

Nestle-Krämling

et al. 2022

Cancers

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Background: Neoadjuvant radiotherapy (naRT) in addition to neoadjuvant chemotherapy (naCT) has been used for locally advanced, inoperable breast cancer or to allow breast conserving surgery (BCS). Retrospective analyses suggest that naRT + naCT might result in an improvement in pathological complete response (pCR rate and disease-free survival). pCR is a surrogate parameter for improved event-free and overall survival (OS) and allows for the adaption of the post-neoadjuvant therapy regimens. However, it is not clear whether pCR achieved with the addition of naRT has the same prognostic value. Patients and methods: We performed a retrospective re-analysis of 356 patients (cT1-cT4/cN0-N+) treated with naRT and naCT with a long-term follow-up. Patients underwent naRT on the breast and regional lymph nodes combined with a boost to the primary tumor. Chemotherapy with different agents was given either sequentially or concomitantly to naRT. We used the Cox proportional hazard regression model to estimate the effect of pCR in our cohort in different subgroups as well as chemotherapy protocols. Clinical response markers correlating with OS were also analyzed. Results: For patients with median follow-ups of 20 years, 10 years, 15 years, 20 years, and 25 years, OS rates were 69.7%, 60.6%, 53.1%, and 45.1%, respectively. pCR was achieved in 31.1% of patients and associated with a significant improvement in OS (HR = 0.58; CI-95%: 0.41–0.80; p = 0.001). The prognostic impact of pCR was evident across breast cancer subtypes and chemotherapy regimens. Multivariate analysis showed that age, clinical tumor and nodal stage, chemotherapy, and pCR were prognostic for OS. Conclusion: NaCT and naRT prior to surgical resection achieve good long-term survival in high-risk breast cancer. pCR after naRT maintains its prognostic value in breast cancer subtypes and across different subgroups. pCR driven by naRT and naCT independently influences long-term survival.

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Section: Discussionmentioning

confidence: 99%

Predictive Factors of Long-Term Survival after Neoadjuvant Radiotherapy and Chemotherapy in High-Risk Breast Cancer

Haussmann

Budach

Nestle-Krämling

et al. 2022

Cancers

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“…In most aggressive cases (stage IIIA–C), the combination of NART and chemotherapy, followed by mastectomy and IBR, has demonstrated a 78.3% 5-year recurrence-free survival and 88.4% 5-year OS rate ( 44 ). Similarly, Ciérvide et al ( 41 , 45 ), evaluated the feasibility and tolerability of primary concurrent radio-chemotherapy in breast cancer patients with localized triple-negative (TN) or HER2 + tumors.…”

Section: Basic Concepts In Breast Reconstructionmentioning

confidence: 99%

Technical consideration for breast reconstruction in patients requiring neoadjuvant or adjuvant radiotherapy: a narrative review

Maita,

Torres-Guzman,

Avila

et al. 2023

Ann Transl Med

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Background and Objective Surgical considerations for breast reconstruction (BR) in patients requiring neoadjuvant radiotherapy (NART) or adjuvant radiotherapy (ART) cannot be understated. The management of irradiated tissue leads surgeons to face several challenges. Therefore, it is essential to comprehensively understand the proper patient selection and preoperative planning to ensure the best outcomes and minimize the risk of complications. This narrative review aims to provide an update and summary of the most important technical considerations every breast surgeon must contemplate reconstructing the irradiated breast. Methods The search strategy was performed on January 10th, 2023. The PubMed, Embase, Cochrane Library, and Web of Science databases were queried to capture all publications regarding surgical considerations in BR of patients undergoing NART and ART. Key Content and Findings This review shows that the effects of radiotherapy (RT) on BR are still being studied. RT represents an essential factor for overall patient survival, and its use is increasing. However, the range of RT treatments across different cancer centers complicates the creation of a single treatment protocol. BR improves women’s quality of life, so finding the proper integration of BR and RT is essential. When deciding on the reconstructive method, there are several factors to consider, such as the patient’s body characteristics, tumor stage, RT protocol, and chemotherapy. To achieve the best surgical results and the most satisfied patient, using less aggressive and safer RT methods in the treatment sequence is recommended. Conclusions The timing of the radiation will influence the selection of the best reconstructive methods to be employed in the breast cancer patient. However, there is clear evidence of preference for immediate autologous-based BR in cases due to the low rate of complications in the long term. But patient individualization is the key. Therefore, the benefits and risks of immediate versus delayed and autologous versus implant-based reconstruction must be weighed in every single case.

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Pre-operative chemoradiotherapy followed by mastectomy and breast reconstruction—A systematic review of clinical, oncological, reconstructive and aesthetic outcomes

Ward,

Ho,

Ike

et al. 2024

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Neoadjuvant chemotherapy and radiotherapy for locally advanced breast cancer: Safety and efficacy of reverse sequence compared to standard technique?

Cited by 3 publications

References 15 publications

Predictive Factors of Long-Term Survival after Neoadjuvant Radiotherapy and Chemotherapy in High-Risk Breast Cancer

Predictive Factors of Long-Term Survival after Neoadjuvant Radiotherapy and Chemotherapy in High-Risk Breast Cancer

Technical consideration for breast reconstruction in patients requiring neoadjuvant or adjuvant radiotherapy: a narrative review

Pre-operative chemoradiotherapy followed by mastectomy and breast reconstruction—A systematic review of clinical, oncological, reconstructive and aesthetic outcomes

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