Cancer Res Treat.  2023 Apr;55(2):592-602. 10.4143/crt.2022.998.

Impact of Postmastectomy Radiation Therapy on Breast Cancer Patients According to Pathologic Nodal Status after Modern Neoadjuvant Chemotherapy

Affiliations
  • 1Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
  • 2Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
  • 3Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea

Abstract

Purpose
The utility of postmastectomy radiation therapy (PMRT) for breast cancer patients after neoadjuvant chemotherapy (NAC) is highly controversial. This study evaluated the impact of PMRT according to pathologic nodal status after modern NAC.
Materials and Methods
We retrospectively reviewed 682 patients with clinical stage II-III breast cancer who underwent NAC and mastectomy from 2013 to 2017. In total, 596 patients (87.4%) received PMRT, and 86 (12.6%) did not. We investigated the relationships among locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), overall survival (OS), and various prognostic factors. Subgroup analyses were also performed to identify patients who may benefit from PMRT.
Results
The median follow-up duration was 67 months. In ypN+ patients (n=368, 51.2%), PMRT showed significant benefits in terms of LRRFS, DFS, and OS (all p < 0.001). In multivariate analyses, histologic grade (HG) III (p=0.002), lymphovascular invasion (LVI) (p=0.045), and ypN2-3 (p=0.02) were significant risk factors for poor LRRFS. In ypN1 patients with more than two prognostic factors among luminal/human epidermal growth factor receptor-2–negative subtype, HG I-II, and absence of LVI, PMRT had no significant effect on LRRFS (p=0.18). In ypN0 patients (n=351, 48.8%), PMRT was not significantly associated with LRRFS, DFS, or OS. However, PMRT showed better LRRFS in triple-negative breast cancer (TNBC) patients (p=0.03).
Conclusion
PMRT had a major impact on treatment outcomes in patients with residual lymph nodes following NAC and mastectomy. Among ypN0 patients, PMRT may be beneficial only for those with TNBC.

Keyword

Breast neoplasms; Neoadjuvant therapy; Postmastectomy radiation therapy; Pathologic nodal stage

Figure

  • Fig. 1 Subgroup analyses of LRRFS according to the use of PMRT in ypN0 patients. ALND, axillary lymph node dissection; HER2, human epidermal growth factor receptor; LRRFS, locoregional recurrence-free survival; NA, not available; PMRT, postnastectomy radiation therapy; RT, radiation therapy; SLNB, sentinel lymph node biopsy. a)Significant p-value.

  • Fig. 2 Subgroup analyses of LRRFS according to the use of PMRT in ypN+ patients. ALND, axillary lymph node dissection; HER2, human epidermal growth factor receptor; LRRFS, locoregional recurrence-free survival; NA, not available; PMRT, postmastectomy radiation therapy; RT, radiation therapy; SLNB, sentinel lymph node biopsy. a)Significant p-value.

  • Fig. 3 Locoregional recurrence-free survival curves of low- (A) and high-risk (B) ypN1 patients according to postmastectomy radiation therapy (PMRT).


Reference

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