Department of Radiation Oncology, Stanford Cancer Institute, Stanford CA.
Department of Radiation Oncology, Stanford Cancer Institute, Stanford CA.
Clin Breast Cancer. 2021 Aug;21(4):373-382. doi: 10.1016/j.clbc.2021.02.008. Epub 2021 Feb 26.
We evaluated the impact of postmastectomy radiotherapy (PMRT) or supraclavicular radiation therapy (SCV RT) in women with cT1-3N1 breast cancer (BC) who became node negative (ypN0) after neoadjuvant chemotherapy (NAC).
We retrospectively reviewed 485 women treated with NAC for BC between 2005 and 2019. Radiation treatment fields were reviewed in detail. Pathologic complete response (pCR) was defined as ypT0/Tis ypN0. Patients who had residual nodal disease were defined as ypN+. Those who achieved complete response in the lymph nodes but not in the breast were defined as ypT+ypN0.
After excluding patients with cT4 and cN0 disease at diagnosis, a total of 185 patients with cT1-3N1 BC were included. Patients were more likely to receive PMRT if they had ypN+ disease (P < .001) and/or lymphovascular invasion (P = .03). Patients who underwent lumpectomy were more likely to receive SCV RT if they did not achieve pCR (P = .04) and/or if they had ypN+ disease (P = .01). The 5-year rates of locoregional recurrence (LRR) were 15% for all patients, 14% for patients who attained ypT+ypN0, and 5% for patients who achieved pCR. Of ypT+ypN0 patients (n = 98), 53 received PMRT or SCV RT and 45 did not. For these patients, there were no differences in LRR based on whether a patient did or did not receive PMRT or SCV RT (P = .23).
Recommendations for or against PMRT or SCV RT after NAC vary based on final pathologic response. We await the results of ongoing randomized clinical trials to help guide clinical decision making in this context.
我们评估了新辅助化疗（NAC）后降期为淋巴结阴性（ypN0）的 cT1-3N1 乳腺癌（BC）患者行保乳术后放疗（PMRT）或锁骨上放疗（SCV RT）的影响。
我们回顾性分析了 2005 年至 2019 年期间接受 NAC 治疗的 485 例 BC 患者。详细审查了放射治疗区域。病理完全缓解（pCR）定义为 ypT0/Tis ypN0。有残留淋巴结疾病的患者定义为 ypN+。在淋巴结完全缓解但乳房未完全缓解的患者定义为 ypT+ypN0。
排除诊断时 cT4 和 cN0 疾病的患者后，共纳入 185 例 cT1-3N1 BC 患者。ypN+疾病（P<0.001）和/或脉管侵犯（P=0.03）的患者更有可能接受 PMRT。未达到 pCR（P=0.04）和/或 ypN+疾病（P=0.01）的保乳术患者更有可能接受 SCV RT。所有患者的局部区域复发（LRR）率为 15%，ypT+ypN0 患者为 14%，pCR 患者为 5%。ypT+ypN0 患者（n=98）中，53 例接受了 PMRT 或 SCV RT，45 例未接受。对于这些患者，是否接受 PMRT 或 SCV RT 与 LRR 无差异（P=0.23）。
NAC 后是否行 PMRT 或 SCV RT 的建议取决于最终的病理反应。我们正在等待正在进行的随机临床试验的结果，以帮助指导这方面的临床决策。
