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- Title
Predictors of locoregional outcome in patients receiving neoadjuvant therapy and postmastectomy radiation.
- Authors
Wright, Jean L.; Takita, Cristiane; Reis, Isildinha M.; Zhao, Wei; Saigal, Kunal; Wolfson, Aaron; Markoe, Arnold; Moller, Mecker; Hurley, Judith
- Abstract
BACKGROUND: The objective of this study was to identify predictors of locoregional recurrence (LRR) after neoadjuvant therapy (NAT) and postmastectomy radiation (PMRT) in a cohort of patients with stage II through III breast cancer and to determine whether omission of the supraclavicular field had an impact on the risk of LRR. METHODS: The authors reviewed records from 464 patients who received NAT and PMRT from January 1999 to December 2009. RESULTS: The median patient age was 50 years (range, 25-81 years). Clinical disease stage was stage II in 29% of patients, stage III in 71%, and inflammatory in 14%. Receptor status was estrogen receptor (ER)-positive in 54% of patients, progesterone receptor (PR)-positive in 39%, human epidermal growth factor receptor 2 (HER2)-positive in 24%, and negative for all 3 receptors (triple negative) in 32%. All patients received NAT and underwent mastectomy, and 19.6% had a complete pathologic response in the breast and axilla, 17.5% received radiation to the chest wall only, and 82.5% received radiation to the chest wall and the supraclavicular field; omission of the supraclavicular field was more common in patients with lower clinical and pathologic lymph node status. The median follow-up was 50.5 months, and the 5-year cumulative incidence of LRR was 6% (95% confidence interval, 3.9%-8.6%). Predictors of LRR were clinical stage III ( P = .038), higher clinical lymph node status ( P = .025), higher pathologic lymph node status ( P = .003), the combination of clinically and pathologically positive lymph nodes ( P < .001), inflammatory presentation ( P = .037), negative ER status ( P = .006), negative PR status ( P = .015), triple-negative status ( P < .001), and pathologic tumor size >2 cm ( P = .045). On univariate analysis, omission of the supraclavicular field was not associated significantly with LRR (hazard ratio, 0.89; P = .833); however, on multivariate analyses, omission of the supraclavicular field was associated significantly with LRR (hazard ratio, 3.39; P = .024). CONCLUSIONS: Presenting stage, receptor status, pathologic response to neoadjuvant therapy, and omission the supraclavicular field were identified as risk factors for LRR after neoadjuvant therapy and PMRT. Cancer 2013. © 2012 American Cancer Society.
- Subjects
ADJUVANT treatment of cancer; MASTECTOMY; CANCER radiotherapy; TREATMENT effectiveness; INFLAMMATION; PROGESTERONE receptors; EPIDERMAL growth factor receptors
- Publication
Cancer (0008543X), 2013, Vol 119, Issue 1, p16
- ISSN
0008-543X
- Publication type
Article
- DOI
10.1002/cncr.27717