Neoadjuvant radiotherapy for locally advanced and high‐risk breast cancer

Abstract

Introduction: Neoadjuvant radiotherapy (NART) as part of a multi-modality approach for locally advanced breast cancer (LABC) requires further investigation. Importantly, this approach may allow for a single-staged surgical procedure, with mastectomy and immediate autologous reconstruction. Multiple other potential benefits of NART include improved pathological downstaging of breast disease, reduced overall treatment time, elimination of time period with breast tissue deficit and improved patient satisfaction. Methods: This is a retrospective multi-institutional review of patients with LABC and high-risk breast disease undergoing NART. Eligible patients sequentially underwent neoadjuvant chemotherapy (NACT) with or without HER2-targeted therapy, NART, followed by mastectomy with immediate autologous breast reconstruction (BR) 4-to 6 weeks post-completion of radiotherapy. Patient and tumour characteristics were analysed using descriptive statistics. Surgical complications were assessed using the Clavien-Dindo Classification (Ann Surg 2004; 240: 205). Results: From 3/2013 to 9/2019, 153 patients were treated with NART. The median age was 47 years (IQR 42-52), with median body mass index of 27. Eighteen patients experienced Grade 3 acute surgical complications. This included 13 Grade 3B breast-site events and 9 Grade 3B donor-site events, where further surgical intervention was required for management of wound infection, wound dehiscence, flap or mastectomy skin necrosis, haematoma and internal mammary venous anastomotic thrombosis. No autologous flap loss was observed. Conclusion: Neoadjuvant radiotherapy facilitates a single-stage surgical procedure with mastectomy and immediate autologous BR, eliminating the delay to reconstructive surgery and thus shortening a woman's breast cancer journey. The findings of this review support the use of NART, with comparable rates of surgical complications to standard sequencing.

Radiomics in the Setting of Neoadjuvant Radiotherapy: A New Approach for Tailored Treatment

“…This strategy is currently used mainly in locally advanced rectal cancer and sarcoma and in a subset of non-small cell lung cancer and esophageal cancer, whereas in other diseases it is still under investigation [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. An evaluation of the efficacy of the induction strategy is made possible by performing imaging investigations before and after the neoadjuvant therapy.…”

Increasing use of post‐mastectomy hypofractionated radiation therapy for breast cancer in Victoria

“…There are multiple other factors that may influence HFRT use which we are not able to evaluate, including tumour factors (such as T and N stage, hormone receptor and Her2 expression status), and treatment factors, such as surgical considerations (immediate or delayed reconstruction), and the use of and timing of systemic therapy. We are not able to distinguish adjuvant RT from neo‐adjuvant RT in women who had RT to CW, noting that there was increasing interest in the use of neo‐adjuvant RT followed by mastectomy and immediate reconstruction in some institutions in Victoria over the study, 31 though we would expect the overall number of patients who have neo‐adjuvant RT is low in our population‐based cohort.…”

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

“…Another recent publication reported on 153 prospectively observed patients with locally advanced breast cancer treated with naRT and naCT [ 41 ]. Overall, 68% were stage III, with all patients undergoing mastectomy.…”

“…These modest rates might be a result of the inclusion of advanced stages and a predominance of HR+ tumors. Another recent publication reported on 153 prospectively observed patients with locally advanced breast cancer treated with naRT and naCT [41]. Overall, 68% were stage III, with all patients undergoing mastectomy.…”