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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2019

01-08-2019 | Mastectomy | Breast Oncology

Role of Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer Patients: A Study from the Japanese Breast Cancer Registry

Authors: Minoru Miyashita, MD, PHD, Naoki Niikura, MD, PHD, Hiraku Kumamaru, MD, PHD, Hiroaki Miyata, MD, PHD, Takayuki Iwamoto, MD, PHD, Masaaki Kawai, MD, PHD, Keisei Anan, MD, PHD, Naoki Hayashi, MD, PHD, Kenjiro Aogi, MD, PHD, Takanori Ishida, MD, PHD, Hideji Masuoka, MD, PHD, Kotaro Iijima, MD, PHD, Shinobu Masuda, MD, PHD, Koichiro Tsugawa, MD, PHD, Takayuki Kinoshita, MD, PHD, Hitoshi Tsuda, MD, PHD, Seigo Nakamura, MD, PHD, Yutaka Tokuda, MD, PHD

Published in: Annals of Surgical Oncology | Issue 8/2019

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Abstract

Background

The role of postmastectomy radiotherapy (PMRT) in breast cancer patients receiving neoadjuvant chemotherapy (NAC) is controversial. We aimed to evaluate the effectiveness of radiotherapy in patients treated with NAC and mastectomy in the Japanese Breast Cancer Registry.

Methods

We enrolled patients who received NAC and mastectomy for cT1–4 cN0–2 M0 breast cancer. We evaluated the association between radiotherapy and outcomes, locoregional recurrence (LRR), distant disease-free survival (DDFS), and overall survival (OS) based on ypN status by multivariable analysis.

Results

Of the 145,530 patients, we identified 3226 who met the inclusion criteria. Among ypN1 patients, no differences were found in LRR, DDFS, or OS between groups with and without radiotherapy (p = 0.72, p = 0.29, and p = 0.36, respectively). Radiotherapy was associated with improved LRR-free survival (p < 0.001), DDFS (p = 0.01), and OS (p < 0.001) in patients with ypN2–3. Multivariable analysis demonstrated that use of radiotherapy was independently associated with improved LRR [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.45–0.82, p = 0.001] and OS [HR 0.69, 95% CI 0.53–0.89, p = 0.004) for ypN2–3 patients only. The association between radiotherapy and OS was not statistically significant among ypN0 (p = 0.22) and ypN1 patients (p = 0.51).

Conclusions

The results from this nationwide database study did not show significant associations between PMRT and improved survival among ypN0 and ypN1 patients. Radiotherapy may be beneficial only for ypN2–3 breast cancer patients who receive NAC and mastectomy in the modern era.
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Metadata
Title
Role of Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer Patients: A Study from the Japanese Breast Cancer Registry
Authors
Minoru Miyashita, MD, PHD
Naoki Niikura, MD, PHD
Hiraku Kumamaru, MD, PHD
Hiroaki Miyata, MD, PHD
Takayuki Iwamoto, MD, PHD
Masaaki Kawai, MD, PHD
Keisei Anan, MD, PHD
Naoki Hayashi, MD, PHD
Kenjiro Aogi, MD, PHD
Takanori Ishida, MD, PHD
Hideji Masuoka, MD, PHD
Kotaro Iijima, MD, PHD
Shinobu Masuda, MD, PHD
Koichiro Tsugawa, MD, PHD
Takayuki Kinoshita, MD, PHD
Hitoshi Tsuda, MD, PHD
Seigo Nakamura, MD, PHD
Yutaka Tokuda, MD, PHD
Publication date
01-08-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07453-1

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