Role of Elective Nodal Irradiation in Patients With ypN0 After Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery (KROG 16-16)

Won Kyung Cho, Won Park, Doo Ho Choi, Yong Bae Kim, Jin Ho Kim, Su Ssan Kim, Kyubo Kim, Jin Hee Kim, Sung Ja Ahn, Sun Young Lee, Jeongshim Lee, Sang Won Kim, Jeanny Kwon, Ki Jung Ahn

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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.

Original languageEnglish
Pages (from-to)78-86
Number of pages9
JournalClinical Breast Cancer
Volume19
Issue number1
DOIs
Publication statusPublished - 2019 Feb

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Segmental Mastectomy
Disease-Free Survival
Drug Therapy
Survival
Progesterone Receptors
Lymph Node Excision
Estrogen Receptors
Neoplasms
Adjuvant Radiotherapy
Radiation Oncology
Survival Rate

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Cho, Won Kyung ; Park, Won ; Choi, Doo Ho ; Kim, Yong Bae ; Kim, Jin Ho ; Kim, Su Ssan ; Kim, Kyubo ; Kim, Jin Hee ; Ahn, Sung Ja ; Lee, Sun Young ; Lee, Jeongshim ; Kim, Sang Won ; Kwon, Jeanny ; Ahn, Ki Jung. / Role of Elective Nodal Irradiation in Patients With ypN0 After Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery (KROG 16-16). In: Clinical Breast Cancer. 2019 ; Vol. 19, No. 1. pp. 78-86.
@article{c895642b78ee4e998e39648469f9ba9c,
title = "Role of Elective Nodal Irradiation in Patients With ypN0 After Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery (KROG 16-16)",
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.",
author = "Cho, {Won Kyung} and Won Park and Choi, {Doo Ho} and Kim, {Yong Bae} and Kim, {Jin Ho} and Kim, {Su Ssan} and Kyubo Kim and Kim, {Jin Hee} and Ahn, {Sung Ja} and Lee, {Sun Young} and Jeongshim Lee and Kim, {Sang Won} and Jeanny Kwon and Ahn, {Ki Jung}",
year = "2019",
month = "2",
doi = "10.1016/j.clbc.2018.08.009",
language = "English",
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pages = "78--86",
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Cho, WK, Park, W, Choi, DH, Kim, YB, Kim, JH, Kim, SS, Kim, K, Kim, JH, Ahn, SJ, Lee, SY, Lee, J, Kim, SW, Kwon, J & Ahn, KJ 2019, 'Role of Elective Nodal Irradiation in Patients With ypN0 After Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery (KROG 16-16)', Clinical Breast Cancer, vol. 19, no. 1, pp. 78-86. https://doi.org/10.1016/j.clbc.2018.08.009

Role of Elective Nodal Irradiation in Patients With ypN0 After Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery (KROG 16-16). / Cho, Won Kyung; Park, Won; Choi, Doo Ho; Kim, Yong Bae; Kim, Jin Ho; Kim, Su Ssan; Kim, Kyubo; Kim, Jin Hee; Ahn, Sung Ja; Lee, Sun Young; Lee, Jeongshim; Kim, Sang Won; Kwon, Jeanny; Ahn, Ki Jung.

In: Clinical Breast Cancer, Vol. 19, No. 1, 02.2019, p. 78-86.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Role of Elective Nodal Irradiation in Patients With ypN0 After Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery (KROG 16-16)

AU - Cho, Won Kyung

AU - Park, Won

AU - Choi, Doo Ho

AU - Kim, Yong Bae

AU - Kim, Jin Ho

AU - Kim, Su Ssan

AU - Kim, Kyubo

AU - Kim, Jin Hee

AU - Ahn, Sung Ja

AU - Lee, Sun Young

AU - Lee, Jeongshim

AU - Kim, Sang Won

AU - Kwon, Jeanny

AU - Ahn, Ki Jung

PY - 2019/2

Y1 - 2019/2

N2 - 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.

AB - 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.

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U2 - 10.1016/j.clbc.2018.08.009

DO - 10.1016/j.clbc.2018.08.009

M3 - Article

C2 - 30241965

AN - SCOPUS:85053722564

VL - 19

SP - 78

EP - 86

JO - Clinical Breast Cancer

JF - Clinical Breast Cancer

SN - 1526-8209

IS - 1

ER -