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Role of Elective Nodal Irradiation in Patients With ypN0 After Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery (KROG 16-16)
- Source :
- Clinical Breast Cancer. 19:78-86
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Background Given the lack of established indications for elective nodal irradiation (ENI) in ypN0 patients after neoadjuvant chemotherapy (NAC) and breast-conserving surgery (BCS), we set out to investigate the role of ENI in ypN0 patients according to subtype and pathologic complete remission (pCR) status. Patients and Methods We analyzed 261 patients who received NAC followed by BCS and adjuvant radiotherapy in 13 institutions of the Korean Radiation Oncology Group from 2005 to 2011. The tumors were classified into one of 3 subtypes: luminal (estrogen receptor positive or progesterone receptor positive and HER2 negative), HER2 (HER2 positive), or triple negative (estrogen receptor, progesterone receptor, and HER2 negative). We compared locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) according to ENI in different subgroups generated by the subtype and pCR statuses. Results In all patients, the 5-year LRC, DFS, and OS rates were 96.0%, 91.0%, and 96.8%, respectively. In all patients, axillary lymph node dissection was found to be the only favorable factor for LRC (P = .023) and DFS (P = .001). Age ≥ 50 years (P = .027), negative resection margin (P = .002), and axillary lymph node dissection (P = .002) were all favorable factors for OS. ENI did not affect LRC, DFS, or OS. Subgroup analysis by tumor subtype and pCR showed that ENI was not associated with greater LRC or DFS in any subgroups. Conclusion In ypN0 patients after NAC and BCS, ENI did not improve LRC or survival, regardless of subtype or primary tumor response. This result should be verified through larger prospective trials.
- Subjects :
- 0301 basic medicine
Oncology
Cancer Research
medicine.medical_specialty
Receptor, ErbB-2
medicine.medical_treatment
Breast Neoplasms
Mastectomy, Segmental
03 medical and health sciences
0302 clinical medicine
Breast cancer
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
Progesterone receptor
medicine
Breast-conserving surgery
Humans
Neoadjuvant therapy
Neoplasm Staging
Retrospective Studies
business.industry
Carcinoma, Ductal, Breast
Axillary Lymph Node Dissection
Middle Aged
medicine.disease
Combined Modality Therapy
Primary tumor
Neoadjuvant Therapy
Survival Rate
Radiation therapy
Carcinoma, Lobular
030104 developmental biology
Receptors, Estrogen
030220 oncology & carcinogenesis
Resection margin
Female
Radiotherapy, Adjuvant
Lymph Nodes
Neoplasm Recurrence, Local
Receptors, Progesterone
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 15268209
- Volume :
- 19
- Database :
- OpenAIRE
- Journal :
- Clinical Breast Cancer
- Accession number :
- edsair.doi.dedup.....8e571227a8c08743a44d1e4b7ac19283