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The American Society of Breast Surgeons.
Annals of Surgical Oncology

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Post-Mastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer: A Pooled Retrospective Analysis of Three Prospective Randomized Trials

David Krug MD, Bianca Lederer PhD, Fenja Seither MSc, Valentina Nekljudova PhD, Beyhan Ataseven MD, Jens-Uwe Blohmer MD, Serban Dan Costa MD, Carsten Denkert MD, Nina Ditsch MD, Bernd Gerber MD, Claus Hanusch MD, Joerg Heil MD, Jörn Hilfrich MD, Jens B. Huober MD, Christian Jackisch MD, Sherko Kümmel MD, Stefan Paepke MD, Christian Schem MD, Andreas Schneeweiss MD, Michael Untch MD, Jürgen Debus M
Breast Oncology
Volume 26, Issue 12 / November , 2019

Abstract

Background

The impact of locoregional radiotherapy (RT) after neoadjuvant chemotherapy (NACT) and mastectomy in breast cancer patients is currently unclear. Several publications have suggested that patients with a favorable response to NACT might not benefit from RT after mastectomy.

Methods

A retrospective analysis of three prospective randomized NACT trials was performed. Information on the use of RT was available for 817 breast cancer patients with non-inflammatory breast cancer who underwent mastectomy after NACT within the GeparTrio, GeparQuattro, and GeparQuinto-trials. RT was administered to 676 of these patients (82.7%).

Results

The 5-year cumulative incidence of locoregional recurrence (LRR) was 15.2% (95% confidence interval [CI] 9.0–22.8%) in patients treated without RT and 11.3% in patients treated with RT (95% CI 8.7–14.3%). In the multivariate analysis, RT was associated with a lower risk of LRR (hazard ratio 0.51, 95% CI 0.27–1.0; p = 0.05). This effect was shown especially in patients with cT3/4 tumors, as well as in patients who were cN+ before neoadjuvant therapy, including those who converted to ypN0 after neoadjuvant therapy. In the bivariate analysis, disease-free survival was significantly worse in patients who received RT, however this was not confirmed in the multivariate analysis.

Conclusions

Our results suggest that RT reduces the LRR rates in breast cancer patients who receive a mastectomy after NACT without an improvement in DFS. Prospective randomized controlled trials such as the National Surgical Adjuvant Breast and Bowel Project B-51/RTOG 1304 trial will analyze whether RT has any benefit in patients who have a favorable response after NACT.

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