Postmastectomy Radiation Therapy Based on Pathologic Nodal Status in Clinical Node-Positive Stage II to III Breast Cancer Treated with Neoadjuvant Chemotherapy

Huang, Zhou; Zhu, Lihong; Huang, Xiaobo; Tang, Yu; Rong, Qinglin; Shi, Mei; Wang, Weihu; Tie, Jian Ke; Shen, Liangfang; Chen, Jiayi; Zhang, Jun; Wu, Hong-Fen; Cheng, Jing; Liu, Min; Tan, Yuting; Ma, C; Wang, Shulian; Li, Yexiong

doi:10.1016/j.ijrobp.2020.06.028

Cited by 14 publications

(14 citation statements)

References 25 publications

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“…The initial search on PubMed yielded 1837 studies. After applying the inclusion and exclusion criteria, 13 studies were included in the meta-analysis [13] , [14] , [15] , [16] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] . Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The analysis on the impact of LRRT on LRR included six studies ( Fig. 2 A) [15] , [20] , [21] , [22] , [23] , [24] . In total, 2388 patients with N+ at diagnosis and ypN0 after NACT were included in the analysis, 859 received LRRT and 1529 did not.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies investigated the role of LRRT on DFS were eligible ( Fig. 2 B) [20] , [22] , [23] , [24] , [26] . A total of 2019 patients were included in the analysis out of which 626 received LRRT and 1393 did not.…”

Section: Resultsmentioning

confidence: 99%

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Adjuvant locoregional radiation therapy in breast cancer patients with pathologic complete response after neoadjuvant chemotherapy: A systematic review and meta-analysis

Nikyar

Tegnelius

Valachis

2022

Clinical and Translational Radiation Oncology

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The aim of the present meta-analysis was to investigate the impact of adjuvant locoregional radiation therapy (LRRT) in breast cancer patients with clinical lymph node metastatic disease achieving ypN0 after neoadjuvant chemotherapy (NACT). Materials and methods: A systematic review of studies on PubMed was performed. A meta-analysis was conducted by computing extracted hazard ratios (HRs) and 95% confidence intervals (CIs) into a fixed-effects model. Results: Thirteen studies were included in the meta-analysis. Adjuvant LRRT significantly reduced the risk of locoregional recurrence (LRR) in patients with N+ at diagnosis and ypN0 (HR 0.59; 95% CI 0.42-0.81). However, no statistically significant difference on disease-free survival (DFS) or overall survival (OS) was found. Conclusions: LRRT significantly reduced the risk of LRR in patients with ypN0 after NACT whereas no impact on DFS or OS was observed. The low level of evidence should be considered when interpreting the results in clinical practice.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Adjuvant locoregional radiation therapy in breast cancer patients with pathologic complete response after neoadjuvant chemotherapy: A systematic review and meta-analysis

Nikyar

Tegnelius

Valachis

2022

Clinical and Translational Radiation Oncology

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“…Scodan et al and Cho et al suggested that PMRT is beneficial in patients with ypN+ disease after receiving NAC, but not in those with ypN0 disease [ 21 , 29 ]. Furthermore, some researchers argued that PMRT can also be omitted in patients with ypN1 disease [ 30 , 31 ]. Conversely, Rusthoven et al and Krug et al reported that PMRT is helpful in ypN0 patients if the patient was initially classified as having a cN+ disease [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Post-Mastectomy Radiotherapy on Survival Outcomes in Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy

Lee

Kim

Bae

et al. 2021

Cancers

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This study aimed to determine whether post-mastectomy radiotherapy (PMRT) is beneficial for the prognosis of patients who achieved pathologic complete response (pCR), or who had minimal residual disease, after undergoing neoadjuvant chemotherapy (NAC). Patients who underwent a total mastectomy between 2006 and 2018, after NAC, were included. Patients who did not receive PMRT were matched using 1:3 propensity score matching (PSM). Kaplan–Meier survival curves were used to compare locoregional recurrence-free survival (LRRFS) and overall survival (OS). A total of 368 patients were included after 1:3 PSM. PMRT improved the LRRFS (p = 0.016) and OS (p = 0.017) rates of patients who underwent NAC. However, PMRT did not affect the prognosis of patients with pCR (LRRFS: p = 0.999; OS: p = 0.453). In addition, PMRT had a limited effect on LRRFS and OS in patients who responded well to NAC, with a neoadjuvant response index (NRI) value of 0.7–1.0 (LRRFS: p = 0.568; OS: p = 0.875). PMRT improved the OS of patients with a large residual tumor burden, such as nodal metastases or pathologic stage II/III. The benefits of PMRT vary depending on the patients’ response to NAC, although PMRT is useful for treating patients who underwent NAC. PMRT can be omitted, not only in patients with pCR, but also in good responders with an NRI value of 0.7–1.0.

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“…After mastectomy and RNI, no significant survival benefit was reported in ypN0 cases, suggesting the possibility of treatment omission in a selected group of patients. Similarly, patients with node-positive stage II to III BC were retrospectively analysed by Huang et al [10]. Postmastectomy radiotherapy (PMRT) significantly improved OS in the ypN2-3 group, whereas no benefit in the ypN0 and ypN1 groups was reported.…”

Section: Regional Node Irradiation For Breast Cancer With Pathologica...mentioning

confidence: 99%

Radiation therapy on the axilla after neoadjuvant chemotherapy

Meattini

Salvestrini

Becherini

2022

Current Opinion in Oncology

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Purpose of reviewThe introduction of primary systemic therapy has established a new treatment paradigm for breast cancer patients. However, recommendations for regional node irradiation after neoadjuvant chemotherapy are not supported by level I evidence, yet.Recent findingsIn addition to strategies optimising systemic treatments and surgery, current discussions focus on tailoring radiation therapy for breast cancer. Especially in view of the increasingly pivotal role of neoadjuvant chemotherapy, gauging the extent of radiation therapy in the breast and nodal volumes.SummaryThe current review focuses on recent evidence regarding radiation therapy of the breast and axilla in patients receiving neoadjuvant chemotherapy for primary breast cancer based on a PubMed and EMBASE literature search for publication years 2020–2022.

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Postmastectomy Radiation Therapy Based on Pathologic Nodal Status in Clinical Node-Positive Stage II to III Breast Cancer Treated with Neoadjuvant Chemotherapy

Cited by 14 publications

References 25 publications

Adjuvant locoregional radiation therapy in breast cancer patients with pathologic complete response after neoadjuvant chemotherapy: A systematic review and meta-analysis

Adjuvant locoregional radiation therapy in breast cancer patients with pathologic complete response after neoadjuvant chemotherapy: A systematic review and meta-analysis

The Impact of Post-Mastectomy Radiotherapy on Survival Outcomes in Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy

Radiation therapy on the axilla after neoadjuvant chemotherapy

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