| Part ?:The role of postmastectomy radiotherapy in clinical T1-3N1M0 breast cancer patients with pathological negative lymph nodes after neoadjuvant chemotherapy and mastectomyObjective:To analyze the outcomes of clinical T1-3N1M0 breast cancer patients with pathological negative axillary lymph nodes(ypNO)after neoadjuvant chemotherapy(NAC)and mastectomy,and investigate the role of postmastectomy radiotherapy(PMRT)in such patients.Methods:A total of 185 patients with clinical T1-3N1M0 breast cancer treated between 1999 and 2013 were retrospectively reviewed.All patients were treated with NAC and mastectomy,and achieved ypNO.Of them,89 patients received additional PMRT and 96 patients did not.One hundred and one patients had clinical stage ? disease,and 84 patients had clinical stage ? disease.The rates of locoregional recurrence(LRR),distant metastasis(DM),disease-free survival(DFS),and overall survival(OS)were calculated using the Kaplan-Meier method,and differences were compared using the log-rank test.Results:The 5-year LRR,DM,DFS,and OS rates for all patients were 4.5%,10.4%,86.6%,and 97.1%,respectively.The 5-year LRR,DM,DFS and OS rates were 1.1%,5.1%,95.0%,and 100%for patients with PMRT,compared with 7.5%(P = 0.071),15.0%(P?0.023),79.0%(P = 0.008),and 94.5%(P = 0.089)for patients without PMRT,respectively.In the subgroup of Stage ? disease,the 5-year DM and DFS rates were 0%and 100%for patients with PMRT,compared with 11.5%(P = 0.044)and 84.9%(P =0.023)for patients without PMRT,respectively.For patients with Stage ? disease,for patients with and without PMRT,the 5-year LRR and DFS rates were 1.9%and 91.9%for patients with PMRT,compared with 14.4%(P = 0.041)and 67.4%(P = 0.022)for patients without PMRT,respectively.Conclusion:The LRR rate of clinical T1-3N1M0 breast cancer patients who achieved ypN0 after NAC and mastectomy was very low.PMRT decreased DM and increased DFS rate in all patients,and significantly decreased LRR in Stage ? disease.PMRT should be considered for patients with Stage III disease,and further research is warranted to investigate the benefit of PMRT for Stage II disease.Part II:The role of postmastectomy radiotherapy in locally advanced breast cancer patients treated with neoadjuvant chemotherapy and mastectomyObjective:To evaluate the efficacy of radiotherapy in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy,and investigate the possibility of individualizing radiotherapy according to response after neoadjuvant chemotherapy.Methods:A total of 523 patients with clinical stage ?A and ?B breast cancer treated between 1999 and 2013 were retrospectively reviewed.All patients received neoadjuvant chemotherapy and mastectomy.Of them,404 patients received postmastectomy radiotherapy(PMRT)and 119 patients did not.The locoregional recurrence(LRR),disease-free Survival(DFS)and overall survival(OS)rates were calculated using the Kaplan-Meier method,and differences were compared using the log-rank test.Multivariate prognostic analysis was performed using the Cox regression model.Results:For patients with and without PMRT,the 5-year LRR rates were 13.9%versus 24.8%(P = 0.013),DFS were 64.1%versus 53.9%(P = 0.048),and OS were 83.2%versus 78.2%(P = 0.389),respectively.In the subgroups of patients with ypT3-4,ypN2-3 and Stage ? disease,PMRT significantly reduced LRR(P<0.05 for all comparisons),and improved DFS and OS(P<0.05 for all comparisons).Of the 158 patients who achieved ypNO,the 5-year rates of LRR,DFS and OS were 1.0%,89.9%and 96.9%for patients with PMRT,compared with 12.4%(P = 0.004),70.1%(P = 0.009),and 95.8%(P=0.802)for patients without PMRT,respectively.Of 41 patients who achieved pCR,2 patients developed LRR.Multivariate analysis indicated that the omission of PMRT was an independent prognostic factor associated with increased LRR and decreased DFS for all patients and ypNO patients.Conclusion:For patients with clinical stage ?A and ?B breast cancer treated with neoadjuvant chemotherapy and mastectomy,PMRT significantly reduced LRR for all patients,and reduced both recurrence and mortality risk for patients presenting with ypT3-4,ypN2-3 and pathologic stage ?.PMRT might not be omitted safely for patients who achieved ypNO or pCR,and further research is warranted.Part ?:The prognostic factors and treatment outcomes of breast cancer patients treated with breast conserving surgery and adjuvant radiotherapy after neoadjuvant chemotherapy.Objective:To analyze the outcomes of breast cancer patients treated with breast conserving surgery(BCS)and adjuvant radiotherapy(RT)after neoadjuvant chemotherapy(NAC),and identify prognostic factors of locoregional recurrence.Methods:A total of 97 breast cancer patients treated with BCS and RT after NAC between 1999 and 2013 were retrospectively reviewed.All patients received RT to the whole breast after BCS.There were 4 clinical stage I disease,61 stage ? disease and 32 stage ? disease.The rates of local recurrence(LR),locoregional recurrence(LRR),distant metastasis(DM),disease-free survival(DFS)and overall survival(OS)were calculated using the Kaplan-Meier method,and differences were compared using the log-rank test.Results:Of overall patients treated with NAC in our institute,the persent of BCS patients was 8.2%.For BCS patients,the rate of clinical response to NAC was 84.5%,and 81.4%patients achieved primary tumors downstaged,according to pathologic stage.With a median follow-up of 66 months,5 patients had ipsilateral breast recurrence,5 patients had regional recurrence,and 15 patients had DM.The 5-year rates of LR,LRR,DM,DFS and OS for all patients were 5.7%,9.9%,13.2%,80.3%and 98.9%,respectively.In univariate analysis,there was no prognostic factor affecting LRR significantly.Conclusion:Breast conserving surgery and adjuvant radiotherapy performed selectively after neoadjuvant chemotherapy is safe,and the LRR is acceptably low.Further study is warranted to identify risk factors of LRR for further individualized treatment. |
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