Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.
National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.
Ann Surg Oncol. 2019 Nov;26(12):3892-3901. doi: 10.1245/s10434-019-07635-x. Epub 2019 Jul 26.
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.
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%).
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.
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.
新辅助化疗（NACT）和乳房切除术治疗后局部区域放疗（RT）对乳腺癌患者的影响目前尚不清楚。有几项研究表明，对 NACT 有良好反应的患者在乳房切除术后可能不会从 RT 中获益。
对三个前瞻性随机 NACT 试验进行了回顾性分析。在 GeparTrio、GeparQuattro 和 GeparQuinto 试验中，有 817 例非炎性乳腺癌患者接受 NACT 后行乳房切除术，其中有 676 例患者（82.7%）的 RT 信息可用。
未接受 RT 治疗的患者 5 年局部区域复发（LRR）累积发生率为 15.2%（95%CI 9.0-22.8%），接受 RT 治疗的患者为 11.3%（95%CI 8.7-14.3%）。多变量分析显示，RT 与 LRR 风险降低相关（风险比 0.51，95%CI 0.27-1.0；p=0.05）。这种效果尤其在 cT3/4 肿瘤患者和新辅助治疗前 cN+的患者中显现，包括新辅助治疗后转化为 ypN0 的患者。在二元分析中，接受 RT 的患者无病生存率显著较差，但在多变量分析中未得到证实。
我们的结果表明，在接受 NACT 后行乳房切除术的乳腺癌患者中，RT 可降低 LRR 率，但不能改善无病生存率。国家外科辅助乳腺和肠道项目 B-51/RTOG 1304 试验等前瞻性随机对照试验将分析对 NACT 后反应良好的患者 RT 是否有获益。
