Does Failure to Achieve Pathologic Complete Response with Neoadjuvant Chemotherapy Identify Node-Negative Patients Who W
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ORIGINAL ARTICLE – BREAST ONCOLOGY
Does Failure to Achieve Pathologic Complete Response with Neoadjuvant Chemotherapy Identify Node-Negative Patients Who Would Benefit from Postmastectomy Radiation or Regional Nodal Irradiation? Angelena Crown, MD1, Mithat Gonen, PhD2, Tiana Le, BA1, and Monica Morrow, MD1 1
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; 2Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
ABSTRACT Background. Postmastectomy radiation (PMRT) and regional nodal irradiation (RNI) improve outcomes for patients at high risk of locoregional recurrence (LRR). Node-negative patients with the triple-negative (TN) subtype and those who do not have a pCR with neoadjuvant chemotherapy (NAC) are at increased risk for LRR, but whether the absolute risk for LRR is high enough to justify PMRT/RNI is uncertain. Methods. Patients with cT1-T3N0 and pN0 disease treated with NAC who had residual disease in the breast were identified from a prospective database. Patients were eligible for the study if they had mastectomy or breastconserving therapy with negative margins and whole-breast radiation. Those receiving PMRT or RNI were excluded. Actuarial rates were estimated using the cumulative incidence function. Results. The 227 patients in this study had a mean age was 51.4 ± 12.6 years, and 82 (36.1%) were TN. During a median follow-up period of 35 months, nine LRR events occurred. The overall crude and actuarial 3-year LRR rates were 4.4% and 5.9%, respectively. The crude LRR rate for
Presented in poster format at the Society of Surgical Oncology 2020 International Conference on Surgical Cancer Care, August 2020, Virtual Meeting. Ó Society of Surgical Oncology 2020 First Received: 5 June 2020 Accepted: 23 August 2020 M. Morrow, MD e-mail: [email protected]
the TN patients was 7.4%, and the 3-year actuarial rate was 10.1%. The hormone receptor-positive (HR?) and human epidermal growth factor receptor 2-negative (HER2-) patients had a crude LRR rate of 2.8% and a 3-year actuarial rate of 3.2%. The HER2? patients had a crude LRR rate of 2.7% and a 3-year actuarial rate of 3.3%. Conclusions. Locoregional recurrence is uncommon for patients with node-negative HR?/HER2and HER2? tumors who have residual disease in the breast; however, TN patients have LRR rates that approach 10% at 3 years, suggesting a possible role for PMRT/RNI for node-negative TN patients. Additional follow-up with more patients is needed for definitive conclusions.
Predictors of locoregional recurrence (LRR) in patients who have early-stage breast cancer treated with upfront surgery are well-defined and inform decision-making regarding adjuvant systemic and radiation therapy.1–4 Postmastectomy radiation therapy (PMRT) and regional nodal irradiation (RNI) confer a survival benefit in the setting of nodal metastases and are routinely recommended for patients with positive nodes.5–10 Two randomized trials of RNI, the European Organizati
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