Use of Preoperative Radiation Therapy in Early-stage and Locally Advanced Breast Cancer

Abstract

PurposeThere is growing interest in delivering radiation preoperatively (preopRT) rather than postoperatively (postopRT) for breast cancer. Using the National Cancer Database, we evaluated the use and outcomes of preopRT in breast cancer.MethodsWe identified adult females diagnosed with non-metastatic breast cancer treated with definitive surgery and radiation between 2004 and 2014. Logistic regression models evaluated factors associated with use of preopRT in early-stage (clinical T1-3/N0-1) and locally advanced (clinical T4/N2-3) disease. Rates of breast-conserving surgery, breast reconstruction, positive surgical margins, and 30-day surgical readmissions were compared between patients receiving preopRT and postopRT.ResultsOf 373,595 patients who met our inclusion criteria, 1,245 (0.3%) patients received preopRT. Patients receiving preopRT were more likely to be of lower socioeconomic status and have tumors with higher T stage. Younger age and N1 (vs N0) disease predicted for use of preopRT in early-stage disease, while older age and N0 disease predicted for use of preopRT in the locally advanced setting. PreopRT patients were less likely to undergo breast-conserving surgery and more likely to have positive surgical margins. Rates of unplanned readmissions within 30 days of surgery were similar among patients treated with preopRT and postopRT.ConclusionsPreopRT is a new treatment strategy for patients with breast cancer with different clinical and sociodemographic drivers of its use in the early-stage and locally advanced settings. We await the results of clinical trials studying the efficacy of this approach.

Revolutionizing the battle against locally advanced breast cancer: A comprehensive insight into neoadjuvant radiotherapy

“…Moreover, these patients are more likely to develop T3-T4 tumors, more advanced lymph node disease, and triple-negative subtypes. 24 Prior literature also accentuates the socioeconomic disparities among BC patients, reinforcing these findings. Compared to women of higher socioeconomic status, underprivileged patients are…”

“…In this study, it was revealed that younger, African American, uninsured, or Medicaid‐insured patients were more likely to undergo preoperative radiotherapy. Moreover, these patients are more likely to develop T3–T4 tumors, more advanced lymph node disease, and triple‐negative subtypes 24 . Prior literature also accentuates the socioeconomic disparities among BC patients, reinforcing these findings.…”

“…They discovered that patients subjected to preoperative radiotherapy were more susceptible to positive surgical margins and less likely to undergo BCS. Among patients who received both preoperative and postoperative radiotherapy, the rates of unplanned readmissions within 30 days post‐surgery were comparable 24 . However, these results warrant cautious interpretation.…”

“…Among patients who received both preoperative and postoperative radiotherapy, the rates of unplanned readmissions within 30 days post-surgery were comparable. 24 However, these results warrant cautious interpretation. In this study, it was revealed that younger, African American, uninsured, or Medicaid-insured patients were more likely to undergo preoperative radiotherapy.…”

“…25 In Koenig et al's study, patients of lower socioeconomic status, likely due to more advanced disease, may have been selected to receive preoperative NART. 24 3.1.11 | Case study: Certain clinical trials on systemic therapy sequencing in LABC In 2020, Xu et al conducted a randomized clinical trial to assess the impact of systemic therapy sequencing on LABC. In lieu of postoperative radiotherapy, the findings implied that preoperative therapies indeed conferred substantial benefits, such as mitigating side effects, enhancing breast preservation, and improving patient survival.…”