| Objective: Axillary lymph nodes were negative(yp N0)in the patients in the stage Ⅱ andⅢ breast cancer after neoadjuvant chemotherapy.Is it safe to omit the postoperative radiotherapy after the modified radical mastectomy.Methods: Research methods:This study takes "breast neoplasms," "Neoadjuvant Therapy," "radiotherapy," "Lymph nodes," "mastectomy," "breast cancer," "neoadjuvant," "radiotherapy," "lymph node," and "surgery" as the main keywords,which were systematically searched in Pubmed,Medline,Embase,Cochrane library,Wanfang,China.com,and Weip.It retrieved the clinical studies in any knowledge published from1 st January,2007 to 31 st October,2017.The eligible clinical research was included in this analysis,and finally the statistical analysis was carried out by using the Revman5.3statistical analysis software.Results: A total of 260 articles were obtained through the systematic retrieval.After reading the titles and abstracts of the literature,53 articles were selected.Finally,four studies were included in this analysis according to the inclusion criteria and exclusion criteria.The sample size ranged from 106 to 158,including 549 patients from January to August in 2017.The follow-up period differently ranged from 62 months to 91 months.The total recurrence survival rate without the local region of the radiotherapy group was92.3% to 99% in the total of 5years,and the recurrence rate without the local region of the group without radiotherapy was 97.6% to 98.1% in the total of 5 years.The total 5-year disease-free survival rate of the radiotherapy group was 79.2% to 89.9%,and the overall 5-year disease-free survival rate in the non radiotherapy group was 70.1% to91.2%.1.The articles of the randomized controlled studies included a comparison of 849 patients.The 5-year LRRFS of the patients in the stage Ⅱ and Ⅲ breast cancer who underwent the modified radical mastectomy with the negative axillary lymph nodes after the neoadjuvant chemotherapy were as much high as those without radiotherapy in 5years.The difference is not statistically significant.[P=0.10].2.The randomized controlled studies for 3 times were conducted in 443 patients.The postoperative DFS of the patients in the stage Ⅱ and Ⅲ breast cancer who underwent the modified radical mastectomy with the negative axillary lymph nodes without the neoadjuvant chemotherapy are as much high as those with the neoadjuvant chemotherapy.The difference is not statistically significant.[P=0.92].3.The reports included a comparison of 342 patients in the stage Ⅲ breast cancer with negative axillary lymph node pathology after neoadjuvant chemotherapy.The 5-year LRRFS with the radiotherapy was higher in the stage Ⅲ breast cancer patients than in non-radiotherapy patients.The difference isstatistically significant.[P=0.0005].4.The studies included a comparison of 268 patients.Patients with stage Ⅲ breast cancer with negative axillary lymph node pathology after neoadjuvant chemotherapy had the higher DFS after the postoperative radiotherapy than those without the radiotherapy.The difference is statistically related.[P=0.05]Whether there is statistical significance,it still needs to be further studied and verified.5.The studies included a comprison of 282 patients.The patients in the stage Ⅲbreast cancer with the negative axillary lymph node pathology after the neoadjuvant chemotherapy had the higher OS after the postoperative radiotherapy as those without the radiotherapy for 5 years.The difference is not statistically significant.[P=0.12].Conclusion:For stage Ⅲ breast cancer patients,omit radiotherapy are not safety,At the same time,it is suggested that this part of patients should have the sentinel lymph node biopsy after neoadjuvant chemotherapy.if the negative lymph node,radiotherapy can be omited.Ⅱ breast cancer patients,omit radiotherapy are safety,At the same time,it is suggested that this part of patients should have the sentinel lymph node biopsy after neoadjuvant chemotherapy.if the negative lymph node,radiotherapy can be omited. |
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