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Survival and local control rates of triple-negative breast cancer patients treated with boost-IOERT during breast-conserving surgery

Überlebens- und Lokalkontrollraten bei triple-negativen Mammakarzinomen nach brusterhaltender Operation und IOERT als vorgezogenem Tumorbettboost

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Abstract

Aim

The purpose of this work was to retrospectively evaluate survival and local control rates of triple-negative breast cancer subtypes classified as five marker negative (5NP) and core basal (CB), respectively, after breast-conserving surgery and intraoperative boost radiotherapy with electrons (IOERT) followed by whole breast irradiation.

Methods and materials

A total of 71 patients with triple-negative breast cancer were enrolled, who were treated with lumpectomy, axillary lymph node dissection, and IOERT with 9.6 Gy (median Dmax) followed by normofractionated whole breast irradiation to median total doses of 54 Gy. Chemotherapy was applied in a neoadjuvant (12 %), adjuvant (75 %), or combinational setting (7 %).

Results

After a median follow-up of 97 months (range 4–170 months), 5 in-breast recurrences were detected (7.0 %). For all patients, 8-year actuarial rates for local control, metastases-free survival, disease-specific survival, and overall survival amounted to 89, 75, 80, and 69 %, respectively. All local recurrences occurred in grade 3 (G3) tumors irrespective of their specific immunohistochemical phenotype; thus, the local control rate for grades 1/2 (G1/2) was 100 % for both 5NP and CB, while for G3 it was 88 % for 5NP and 90 % for CB (p = 0.65 and 0.82, respectively, n.s.). For disease-specific survival, only the difference of the best-prognosis group 5-NP/G3 vs. the worst-prognosis cohort CB/G1/2 was statistically significant: 90 % vs. 54 % (p = 0.03).

Conclusion

Boost-IOERT provides acceptable long-term in-breast control in triple negative breast cancer. The best subgroup in terms of disease-specific survival was represented by 5NP in combination with tumor grading G3.

Zusammenfassung

Hintergrund

Ziel der Studie war es, im Rahmen einer retrospektiven Analyse Überlebens- und Lokalkontrollraten bei triple-negativen Mammakarzinomen zu untersuchen. Die Tumoren waren in 5NP(5-Marker-negative)- und CB(core basal)-Subtypen klassifiziert und die Patientinnen hatten nach brusterhaltender Operation und intraoperativem Elektronenboost (IOERT) eine Ganzbrustbestrahlung erhalten.

Material und Methoden

Insgesamt 71 Patientinnen mit triple-negativem Mammakarzinom erhielten während einer Lumpektomie und axillärer Lymphknotendissektion eine IOERT (med Dmax 9,6 Gy ) und danach eine Ganzbrustbestrahlung in konventioneller Fraktionierung (mediane Gesamtdosis 54 Gy). Eine Chemotherapie wurde in neoadjuvanter (12 %), adjuvanter (75 %) oder kombinierter (7 %) Sequenz durchgeführt.

Ergebnisse

Nach einer medianen Follow-up-Phase von 97 Monaten (Bereich 4–170) wurden 5 ipsilaterale In-Brust-Rezidive festgestellt (7%). Die aktuarischen Achtjahresraten aller Patientinnen für lokale Kontrolle bzw. metastasenfreies, krankheitsspezifisches und Gesamtüberleben lagen entsprechend bei 89, 75, 80 und 69 %. Unabhängig vom immunhistochemischen Phänotyp traten alle Lokalrezidive bei Tumoren mit niedrigem Differenzierungsgrad G3 auf [Lokalkontrollen: G1/2 (CB und 5NP) 100 % vs. G3 88 % (5NP) und 90 % (CB), p = 0,65 bzw. 0,82; n.s.]. Bezüglich des krankheitsspezifischen Überlebens zeigte der Vergleich zwischen der Subgruppe mit der besten Prognose 5NP/G3 und der mit der schlechtesten Prognose CB/G1/2 statistische Signifikanz: 90 vs. 54 % (p = 0,03).

Zusammenfassung

Bei konservativ operierten triple-negativen Mammakarzinomen erzielt die IOERT als Boostmodalität vor einer Ganzbrustbestrahlung auch langfristig akzeptable Lokalkontrollraten. Die Kombination eines 5NP-Subtyps mit dem Tumordifferenzierungsgrad G3 zeigt einen signifikanten Vorteil im krankheitsspezifischen Überleben.

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Notes

  1. In-breast and regional recurrences together

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Authors and Affiliations

  1. Department of Radiotherapy and Radio-Oncology, Landeskrankenhaus, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria

    Gerd Fastner MD, Franz Zehentmayr MD, Peter Kopp PhD, Christoph Fussl MD, Heinrich Deutschmann MSc & Felix Sedlmayer MD

  2. Department of Special Gynecology, Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria

    Roland Reitsamer MD & Thorsten Fischer MD

  3. Department of Gynecology, Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria

    Roland Reitsamer MD & Thorsten Fischer MD

  4. Department of Pathology, Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria

    Cornelia Hauser-Kronberger MD

  5. Institute of Inborn Errors in Metabolism, Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria

    Angelika Moder PhD

  6. Institute for Research and Development of Advanced Radiation Technologies (radART), Paracelsus Medical University, Salzburg, Austria

    Heinrich Deutschmann MSc

Authors
  1. Gerd Fastner MD
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  2. Cornelia Hauser-Kronberger MD
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  3. Angelika Moder PhD
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  4. Roland Reitsamer MD
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  7. Christoph Fussl MD
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  8. Thorsten Fischer MD
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  9. Heinrich Deutschmann MSc
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  10. Felix Sedlmayer MD
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Correspondence to Gerd Fastner MD.

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Conflict of interest

G. Fastner, C. Hauser-Kronberger, A. Moder, R. Reitsamer, F. Zehentmayr, P. Kopp, C. Fussl, T. Fischer, H. Deutschmann, and F. Sedlmayer state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Fastner, G., Hauser-Kronberger, C., Moder, A. et al. Survival and local control rates of triple-negative breast cancer patients treated with boost-IOERT during breast-conserving surgery. Strahlenther Onkol 192, 1–7 (2016). https://doi.org/10.1007/s00066-015-0895-2

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  • DOI: https://doi.org/10.1007/s00066-015-0895-2

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