Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA.
Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA.
Clin Breast Cancer. 2018 Feb;18(1):e107-e113. doi: 10.1016/j.clbc.2017.07.016. Epub 2017 Aug 1.
Downstaging with neoadjuvant chemotherapy (NAC) might obscure indications for postmastectomy radiation (PMRT). The degree of downstaging that results in local-regional recurrence (LRR) rates low enough to omit PMRT remains controversial. We examined the rate of LRR in women who received NAC who underwent mastectomy without PMRT.
Between 2004 and 2013, 81 women with stage I to IIIA breast cancer had NAC and mastectomy; 48 patients (59%) were clinical N0 and 33 patients (41%) were clinical N1; median age was 45 years; 33 patients (41%) had hormone receptor-positive (HR)HER2, 21 patients (26%) HRHER2, 19 patients (23%) HR HER2, and 7 patients (9%) HRHER2 disease. We explored how LRR rates varied with age, BRCA status, Grade, receptor status, clinical N status, pathologic response, lymphovascular invasion, and mastectomy margins. Median follow-up was 4.9 years.
After NAC, 35 patients (43%) had a pathologic complete response (pCR), 33 patients (41%) were ypN0, and 13 patients (16%) were ypN1-3+. There were 8 LRRs (6 chest wall, 1 axillary, 1 supraclavicular node). The 5-year cumulative incidence of LRR was 8% for all patients, 3% for pCR, 16% for ypN0, 10% for ypN1-3+, 6% for HRHER2, 25% for HRHER2, 0% for HRHER2, and 0% for HRHER2. LRR was 31% in the ypN0 and 33% in the ypN1-3+ HRHER2 women, and 12% in the ypN0 and 0% in the ypN1 to ypN3+ HRHER2 patients.
This study is unique. All HER2 patients received trastuzumab and LRR was analyzed according to treatment response, clinicopathologic factors, and receptor status. pCR patients including young women and clinical stage IIIA had low LRR rates. However, ypN0 and ypN1-3+ HRHER2 patients had higher rates of LRR compared with other receptor subgroups and on the basis of limited data should be considered for PMRT.
新辅助化疗（NAC）降期可能会掩盖乳腺癌根治术后放疗（PMRT）的适应证。降期程度导致局部区域复发（LRR）率足够低而可以省略 PMRT 仍存在争议。我们研究了接受 NAC 后行乳房切除术且未行 PMRT 的女性中 LRR 的发生率。
2004 年至 2013 年间，81 例 I 期至 IIIA 期乳腺癌患者接受 NAC 联合乳房切除术；48 例患者（59%）临床 N0，33 例患者（41%）临床 N1；中位年龄为 45 岁；33 例患者（41%）为激素受体阳性（HR）HER2 阳性，21 例患者（26%）HRHER2 阳性，19 例患者（23%）HR 阳性，7 例患者（9%）HRHER2 阳性疾病。我们探讨了 LRR 率如何随年龄、BRCA 状态、分级、受体状态、临床 N 状态、病理反应、脉管侵犯和乳房切除术切缘而变化。中位随访时间为 4.9 年。
NAC 后，35 例患者（43%）达到病理完全缓解（pCR），33 例患者（41%）ypN0，13 例患者（16%）ypN1-3+。共有 8 例 LRR（6 例胸壁，1 例腋窝，1 例锁骨上淋巴结）。所有患者 5 年 LRR 累积发生率为 8%，pCR 为 3%，ypN0 为 16%，ypN1-3+为 10%，HRHER2 为 6%，HRHER2 为 25%，HRHER2 为 0%，HRHER2 为 0%。ypN0 中的 LRR 为 31%，ypN1-3+中的 HRHER2 为 33%，ypN0 中的 LRR 为 12%，ypN1 至 ypN3+中的 HRHER2 为 0%。
这项研究是独特的。所有 HER2 患者均接受曲妥珠单抗治疗，根据治疗反应、临床病理因素和受体状态分析 LRR。包括年轻女性在内的 pCR 患者和 IIIA 期患者 LRR 发生率较低。然而，ypN0 和 ypN1-3+HRHER2 患者的 LRR 率高于其他受体亚组，基于有限的数据，应考虑对其进行 PMRT。
