Cancer Res Treat.  2019 Jul;51(3):1041-1051. 10.4143/crt.2018.424.

Comparison of Breast Conserving Surgery Followed by Radiation Therapy with Mastectomy Alone for Pathologic N1 Breast Cancer Patients in the Era of Anthracycline Plus Taxane-Based Chemotherapy: A Multicenter Retrospective Study (KROG 1418)

Affiliations
  • 1Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. wonro.park@samsung.com
  • 2Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
  • 3Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. wonro. radiat@snu.ac.kr
  • 4Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
  • 5Department of Radiation Oncology, Kosin University Gospel Hospital, Busan, Korea.
  • 6Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
  • 7Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea.
  • 8Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
  • 9Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
  • 10Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.
  • 11Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan, Korea.
  • 12Department of Radiation Oncology, Chonbuk National University Medical School, Jeonju, Korea.
  • 13Department of Radiation Oncology, Wonju Severance Christian Hospital, Wonju, Korea.

Abstract

PURPOSE
We compared the oncologic outcomes of breast-conserving surgery plus radiation therapy (BCS+RT) and modified radical mastectomy (MRM) under anthracycline plus taxane-based (AT) regimens and investigated the role of adjuvant radiation therapy (RT) in patients with pathologic N1 (pN1) breast cancer treated by mastectomy.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 2,011 patients with pN1 breast cancer who underwent BCS+RT or MRM alone at 12 institutions between January 2006 and December 2010. Two-to-one propensity score matching was performed for balances in variables between the groups.
RESULTS
The median follow-up duration for the total cohort was 69 months (range, 1 to 114 months). After propensity score matching, 1,074 patients (676 in the BCS+RT group and 398 in the MRM-alone group) were analyzed finally. The overall survival, disease-free survival, locoregional failure-free survival, and regional failure-free survival (RFFS) curves of the BCS+RT group vs. MRM-alone group were not significantly different. The subgroup analysis revealed that in the group with both lymphovascular invasion (LVI) and histologic grade (HG) III, the BCS+RT showed significantly superior RFFS (p=0.008). Lymphedema (p=0.007) and radiation pneumonitis (p=0.031) occurred more frequently in the BCS+RT group than in the MRM-alone group, significantly.
CONCLUSION
There are no differences in oncologic outcomes between BCS+RT and MRM-alone groups under the AT chemotherapy regimens for pN1 breast cancer. However, BCS+RT group showed superior RFFS to MRM-alone group in the patients with LVI and HG III. Adjuvant RT might be considerable for pN1 breast cancer patients with LVI and HG III.

Keyword

Breast neoplasms; Pathologic N1; Breast conserving surgery; Radiation Radiotherapy; Mastectomy; Anthracyclines; Taxane; Survival

MeSH Terms

Anthracyclines
Breast Neoplasms*
Breast*
Cohort Studies
Disease-Free Survival
Drug Therapy*
Follow-Up Studies
Humans
Lymphedema
Mastectomy*
Mastectomy, Modified Radical
Mastectomy, Segmental*
Medical Records
Propensity Score
Radiation Pneumonitis
Retrospective Studies*
Anthracyclines

Figure

  • Fig. 1. Survival curves according to treatment group. Overall survival (OS) (A), disease-free survival (DFS) (B), locoregional failure-free survival (LFFS) (C), and regional failure-free survival (RFFS) (D). BCS+RT, breast conserving surgery plus radiation therapy; MRM, modified radical mastectomy.

  • Fig. 2. Subgroup analyses according to risk group for overall survival (OS) (A), disease-free survival (DFS) (B), and regional failure-free survival (RFFS) (C). BCS+RT, breast conserving surgery plus radiation therapy; MRM, modified radical mastectomy; NA, not applicable, a)Hazard ratio was not calculated for RFFS in the low risk group because there was no regional failure in that subgroup.


Reference

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