The role of postmastectomy radiation therapy after neoadjuvant chemotherapy in clinical stage II-III breast cancer patients with pN0: A multicenter, retrospective study (KROG 12-05)

Su Jung Shim, Won Park, Seung Jae Huh, Doo Ho Choi, Kyung Hwan Shin, Nam Kwon Lee, Chang Ok Suh, Ki Chang Keum, Yong Bae Kim, Seung Do Ahn, Su Ssan Kim, Sung W. Ha, Eui Kyu Chie, Kyubo Kim, Hyun Soo Shin, Jin Hee Kim, Hyung Sik Lee

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Abstract

Purpose The purpose of this study was to investigate the role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) in clinical stage II-III breast cancer patients with pN0. Methods and Materials We retrospectively identified 417 clinical stage II-III breast cancer patients who achieved an ypN0 at surgery after receiving NAC between 1998 and 2009. Of these, 151 patients underwent mastectomy after NAC. The effect of PMRT on disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and overall survival (OS) was evaluated by multivariate analysis including known prognostic factors using the Kaplan-Meier method and compared using the log-rank test and Cox proportional regression analysis. Results Of the 151 patients who underwent mastectomy, 105 (69.5%) received PMRT and 46 patients (30.5%) did not. At a median follow-up of 59 months, 5 patients (3.3%) developed LRR (8 sites of recurrence) and 14 patients (9.3%) developed distant metastasis. The 5-year DFS, LRRFS, and OS rates were 91.2, 98.1, and 93.3% with PMRT and 83.0%, 92.3%, and 89.9% without PMRT, respectively (all P values not significant). By univariate analysis, only age (≤40 vs >40 years) was significantly associated with decreased DFS (P=.027). By multivariate analysis, age (≤40 vs >40 years) and pathologic T stage (0-is vs 1 vs 2-4) were significant prognostic factors affecting DFS (hazard ratio [HR] 0.353, 95% confidence interval [CI] 0.135-0.928, P=.035; HR 2.223, 95% CI 1.074-4.604, P=.031, respectively). PMRT showed no correlation with a difference in DFS, LRRFS, or OS by multivariate analysis. Conclusions PMRT might not be necessary for pN0 patients after NAC, regardless of clinical stage. Prospective randomized clinical trial data are needed to assess whether PMRT can be safely omitted in pN0 patients after NAC and mastectomy for clinical stage II-III breast cancer.

Original languageEnglish
Pages (from-to)65-72
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume88
Issue number1
DOIs
Publication statusPublished - 2014 Jan 1

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chemotherapy
breast
Multicenter Studies
radiation therapy
Radiotherapy
Retrospective Studies
cancer
Breast Neoplasms
Drug Therapy
Disease-Free Survival
Mastectomy
Recurrence
Survival
Multivariate Analysis
hazards
Confidence Intervals
confidence
rank tests
intervals
Survival Analysis

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Shim, Su Jung ; Park, Won ; Huh, Seung Jae ; Choi, Doo Ho ; Shin, Kyung Hwan ; Lee, Nam Kwon ; Suh, Chang Ok ; Keum, Ki Chang ; Kim, Yong Bae ; Ahn, Seung Do ; Kim, Su Ssan ; Ha, Sung W. ; Chie, Eui Kyu ; Kim, Kyubo ; Shin, Hyun Soo ; Kim, Jin Hee ; Lee, Hyung Sik. / The role of postmastectomy radiation therapy after neoadjuvant chemotherapy in clinical stage II-III breast cancer patients with pN0 : A multicenter, retrospective study (KROG 12-05). In: International Journal of Radiation Oncology Biology Physics. 2014 ; Vol. 88, No. 1. pp. 65-72.
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abstract = "Purpose The purpose of this study was to investigate the role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) in clinical stage II-III breast cancer patients with pN0. Methods and Materials We retrospectively identified 417 clinical stage II-III breast cancer patients who achieved an ypN0 at surgery after receiving NAC between 1998 and 2009. Of these, 151 patients underwent mastectomy after NAC. The effect of PMRT on disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and overall survival (OS) was evaluated by multivariate analysis including known prognostic factors using the Kaplan-Meier method and compared using the log-rank test and Cox proportional regression analysis. Results Of the 151 patients who underwent mastectomy, 105 (69.5{\%}) received PMRT and 46 patients (30.5{\%}) did not. At a median follow-up of 59 months, 5 patients (3.3{\%}) developed LRR (8 sites of recurrence) and 14 patients (9.3{\%}) developed distant metastasis. The 5-year DFS, LRRFS, and OS rates were 91.2, 98.1, and 93.3{\%} with PMRT and 83.0{\%}, 92.3{\%}, and 89.9{\%} without PMRT, respectively (all P values not significant). By univariate analysis, only age (≤40 vs >40 years) was significantly associated with decreased DFS (P=.027). By multivariate analysis, age (≤40 vs >40 years) and pathologic T stage (0-is vs 1 vs 2-4) were significant prognostic factors affecting DFS (hazard ratio [HR] 0.353, 95{\%} confidence interval [CI] 0.135-0.928, P=.035; HR 2.223, 95{\%} CI 1.074-4.604, P=.031, respectively). PMRT showed no correlation with a difference in DFS, LRRFS, or OS by multivariate analysis. Conclusions PMRT might not be necessary for pN0 patients after NAC, regardless of clinical stage. Prospective randomized clinical trial data are needed to assess whether PMRT can be safely omitted in pN0 patients after NAC and mastectomy for clinical stage II-III breast cancer.",
author = "Shim, {Su Jung} and Won Park and Huh, {Seung Jae} and Choi, {Doo Ho} and Shin, {Kyung Hwan} and Lee, {Nam Kwon} and Suh, {Chang Ok} and Keum, {Ki Chang} and Kim, {Yong Bae} and Ahn, {Seung Do} and Kim, {Su Ssan} and Ha, {Sung W.} and Chie, {Eui Kyu} and Kyubo Kim and Shin, {Hyun Soo} and Kim, {Jin Hee} and Lee, {Hyung Sik}",
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The role of postmastectomy radiation therapy after neoadjuvant chemotherapy in clinical stage II-III breast cancer patients with pN0 : A multicenter, retrospective study (KROG 12-05). / Shim, Su Jung; Park, Won; Huh, Seung Jae; Choi, Doo Ho; Shin, Kyung Hwan; Lee, Nam Kwon; Suh, Chang Ok; Keum, Ki Chang; Kim, Yong Bae; Ahn, Seung Do; Kim, Su Ssan; Ha, Sung W.; Chie, Eui Kyu; Kim, Kyubo; Shin, Hyun Soo; Kim, Jin Hee; Lee, Hyung Sik.

In: International Journal of Radiation Oncology Biology Physics, Vol. 88, No. 1, 01.01.2014, p. 65-72.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The role of postmastectomy radiation therapy after neoadjuvant chemotherapy in clinical stage II-III breast cancer patients with pN0

T2 - A multicenter, retrospective study (KROG 12-05)

AU - Shim, Su Jung

AU - Park, Won

AU - Huh, Seung Jae

AU - Choi, Doo Ho

AU - Shin, Kyung Hwan

AU - Lee, Nam Kwon

AU - Suh, Chang Ok

AU - Keum, Ki Chang

AU - Kim, Yong Bae

AU - Ahn, Seung Do

AU - Kim, Su Ssan

AU - Ha, Sung W.

AU - Chie, Eui Kyu

AU - Kim, Kyubo

AU - Shin, Hyun Soo

AU - Kim, Jin Hee

AU - Lee, Hyung Sik

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Purpose The purpose of this study was to investigate the role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) in clinical stage II-III breast cancer patients with pN0. Methods and Materials We retrospectively identified 417 clinical stage II-III breast cancer patients who achieved an ypN0 at surgery after receiving NAC between 1998 and 2009. Of these, 151 patients underwent mastectomy after NAC. The effect of PMRT on disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and overall survival (OS) was evaluated by multivariate analysis including known prognostic factors using the Kaplan-Meier method and compared using the log-rank test and Cox proportional regression analysis. Results Of the 151 patients who underwent mastectomy, 105 (69.5%) received PMRT and 46 patients (30.5%) did not. At a median follow-up of 59 months, 5 patients (3.3%) developed LRR (8 sites of recurrence) and 14 patients (9.3%) developed distant metastasis. The 5-year DFS, LRRFS, and OS rates were 91.2, 98.1, and 93.3% with PMRT and 83.0%, 92.3%, and 89.9% without PMRT, respectively (all P values not significant). By univariate analysis, only age (≤40 vs >40 years) was significantly associated with decreased DFS (P=.027). By multivariate analysis, age (≤40 vs >40 years) and pathologic T stage (0-is vs 1 vs 2-4) were significant prognostic factors affecting DFS (hazard ratio [HR] 0.353, 95% confidence interval [CI] 0.135-0.928, P=.035; HR 2.223, 95% CI 1.074-4.604, P=.031, respectively). PMRT showed no correlation with a difference in DFS, LRRFS, or OS by multivariate analysis. Conclusions PMRT might not be necessary for pN0 patients after NAC, regardless of clinical stage. Prospective randomized clinical trial data are needed to assess whether PMRT can be safely omitted in pN0 patients after NAC and mastectomy for clinical stage II-III breast cancer.

AB - Purpose The purpose of this study was to investigate the role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) in clinical stage II-III breast cancer patients with pN0. Methods and Materials We retrospectively identified 417 clinical stage II-III breast cancer patients who achieved an ypN0 at surgery after receiving NAC between 1998 and 2009. Of these, 151 patients underwent mastectomy after NAC. The effect of PMRT on disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and overall survival (OS) was evaluated by multivariate analysis including known prognostic factors using the Kaplan-Meier method and compared using the log-rank test and Cox proportional regression analysis. Results Of the 151 patients who underwent mastectomy, 105 (69.5%) received PMRT and 46 patients (30.5%) did not. At a median follow-up of 59 months, 5 patients (3.3%) developed LRR (8 sites of recurrence) and 14 patients (9.3%) developed distant metastasis. The 5-year DFS, LRRFS, and OS rates were 91.2, 98.1, and 93.3% with PMRT and 83.0%, 92.3%, and 89.9% without PMRT, respectively (all P values not significant). By univariate analysis, only age (≤40 vs >40 years) was significantly associated with decreased DFS (P=.027). By multivariate analysis, age (≤40 vs >40 years) and pathologic T stage (0-is vs 1 vs 2-4) were significant prognostic factors affecting DFS (hazard ratio [HR] 0.353, 95% confidence interval [CI] 0.135-0.928, P=.035; HR 2.223, 95% CI 1.074-4.604, P=.031, respectively). PMRT showed no correlation with a difference in DFS, LRRFS, or OS by multivariate analysis. Conclusions PMRT might not be necessary for pN0 patients after NAC, regardless of clinical stage. Prospective randomized clinical trial data are needed to assess whether PMRT can be safely omitted in pN0 patients after NAC and mastectomy for clinical stage II-III breast cancer.

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