Role of Radiation Therapy on the Use of Primary (“Neoadjuvant”) Systemic Treatment of Breast Cancer

Souchon, Rainer; Dunst, Jürgen; Hartmann, Karl

doi:10.1007/s00066-006-1483-2

Cited by 7 publications

(4 citation statements)

References 64 publications

(100 reference statements)

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“…When inoperability criteria prevails, RT should be used for tumour downstaging. Currently, neoadjuvant (NA) RT may be applicable for inoperable breast cancer to allow an effective and sometimes more conservative surgery 6 8. Besides, there is the benefit of eradicating occult micrometastatic disease.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant radiotherapy in the approach of locally advanced breast cancer

et al. 2020

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BackgroundApproximately 4% of European patients are diagnosed with locally advanced breast cancer (LABC), a clinical condition commonly associated with poorer prognosis. Systemic therapy is the recommended initial treatment and when inoperability criteria prevails, radiotherapy (RT) should be used for tumour downstaging. This study intends to evaluate the impact of neoadjuvant radiotherapy (NART) in the treatment of inoperable LABC.MethodsA retrospective study of female patients, submitted to the NART between January 2014 and December 2018 at our institution. The evaluation of pathological response (pR) was made based on Pinder criteria. Primary endpoint: pR. Secondary endpoints: overall survival (OS) and progression-free survival (PFS). OS and PFS were calculated using the Kaplan-Meier method. Differences between groups were compared using Student’s t-test, ANOVA (Analysis of variance) and χ2 test. The statistical analyses were performed using Stata (V.13).ResultsA total of 76 patients were included, 18% with breast complete response. The 5 years OS was 54% and PFS was 61%. Subgroup analysis showed that pR >90% is correlated with a better OS (p=0.004). Basal-like intrinsic subtype is correlated with worse OS and PFS (p<0.05). No relation was found between response and age, intrinsic subtype, treatment performed and clinical T stage.ConclusionOur study confirms that NART is an effective downsizing treatment in inoperable LABC, allowing for a surgical resection regardless of the systemic treatment performed. Response to NART is independent of the intrinsic subtype and pR >90% is correlated with a better OS. Prospective studies to explore predictive response biomarkers are necessary in order to improve patient selection and optimisation of the treatment.

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Section: Introductionmentioning

confidence: 99%

Neoadjuvant radiotherapy in the approach of locally advanced breast cancer

et al. 2020

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“…Based on the results of several trials, postoperative breast cancer radiotherapy was considered mandatory and is a well-established management now, even in case of a noninvasive breast carcinoma [8,9,13,17,20,21]. In order to reduce local relapse and improve survival, adjuvant irradiation has been established [1,11,16].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Irradiation of Left-Sided Breast Cancer Patients and Cardiac Toxicity

Stranzl

Zurl

2008

Strahlenther Onkol

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“…Large randomized trials and statistical studies have established the benefit of PORT in breast cancer, with improved survival and reduced rate of local recurrence in appropriately selected patients [ 9 – 11 ]. Preoperative RT (PRRT), similar to neoadjuvant chemotherapy, may be applicable not only for patients with locally advanced breast cancer and inoperable advanced-stage tumors for BCS but also for those with operable tumors, aiming at breast conservation and higher complete remission rates [ 12 , 13 ]. However, neoadjuvant treatment may also stimulate CSC self-renewal through cytokine production and DNA repair mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Trends and outcomes of neoadjuvant radiotherapy compared with postoperative radiotherapy for malignant breast cancer

Sun

Zhao

et al. 2018

Oncotarget

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BackgroundAlthough neoadjuvant treatment has become the established approach for women with large primary tumors or locally advanced breast cancer for which immediate surgery is not the best approach, it may also stimulate cancer stem cell self-renewal and facilitate recurrence. We sought to determine the survival outcomes of preoperative radiotherapy (PRRT) compared with postoperative radiotherapy (PORT).Materials and MethodsThe Surveillance, Epidemiology, and End Results (SEER) registry was queried for patients who were diagnosed with breast cancer and underwent cancer-directed surgery. Survival analyses were performed with Cox proportional hazard regression for both overall survival (OS) and disease-specific survival (DSS), and 1:1 propensity score (PS) matching-adjusted competing risk analyses were conducted for DSS.ResultsWe first identified 1,111,218 eligible patients in 18 registries from 1973 to 2013 and found that, outside of the Utah registry, sequence patterns other than PORT were rarely used. Thus, we next identified eligible patients registered in Utah (n = 7,042) from 1988 to 2007. The treatment trends shifted abruptly in 1988. Compared with the PORT group, the PRRT group showed significantly higher risks of overall mortality (absolute difference, 22.4%; P < 0.001), breast cancer-specific mortality (absolute difference, 8.6%; P < 0.001), and cardiovascular disease-specific mortality (absolute difference, 11.5%; P = 0.021). Survival differences in treatment sequences were correlated with stage.ConclusionsSubstantial shifts in treatment patterns for malignant breast cancer were identified in Utah. Compared with PORT, PRRT showed significantly worse outcomes. These results could inform future standardized options for radiation sequence with surgery and further clinical trials.

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Role of Radiation Therapy on the Use of Primary (“Neoadjuvant”) Systemic Treatment of Breast Cancer

Cited by 7 publications

References 64 publications

Neoadjuvant radiotherapy in the approach of locally advanced breast cancer

Neoadjuvant radiotherapy in the approach of locally advanced breast cancer

Postoperative Irradiation of Left-Sided Breast Cancer Patients and Cardiac Toxicity

Trends and outcomes of neoadjuvant radiotherapy compared with postoperative radiotherapy for malignant breast cancer

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