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Regional nodal irradiation following pathologic complete response in the axilla to neoadjuvant chemotherapy: patterns of treatment

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Purpose

The role of regional nodal irradiation (RNI) in patients with clinically positive axillary nodes (cN1) who demonstrate a pathologic complete response (CR) in the axilla following neoadjuvant chemotherapy remains unclear and is currently under study. The present study used the National Cancer Data Base (NCDB) to evaluate patterns of care and characteristics associated with receipt of RNI in this population of patients.

Methods and materials

The NCDB was queried for women diagnosed with breast cancer from 2006 to 2012. Patients with nonmetastatic-invasive ductal or lobular carcinoma with clinically positive nodes who underwent neoadjuvant chemotherapy with a pathologic CR in the axilla and known RNI status were included in our analysis.

Results

A total of 4381 patients met inclusion criteria. Within this cohort, 1997 (45.6%) patients received RNI and 2384 (54.4%) did not. On multivariable analysis, factors significantly associated with treatment with RNI included younger age (p = 0.02), shorter distance from hospital (p = 0.01), higher clinical T stage (p < 0.001), presence of lymphovascular space invasion (LVSI) (p = 0.001), greater number of examined nodes (p < 0.001), and use of adjuvant systemic therapy (p < 0.001). RNI was used in 51.8% of patients ages 18–29, 47.6% for ages 30–49, 45.0% for ages 50–69, and 29.9% for ages >69 years. Among patients who received adjuvant systemic therapy, RNI was used in 51.0% of cases, compared with 43.0% for those not receiving adjuvant systemic therapy.

Conclusions

In this large cancer database study, we observed substantial variation in the use of RNI in clinically node-positive patients with pathologic CR following neoadjuvant chemotherapy based on patient-, tumor-, and treatment-related factors.

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Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA

    Surbhi Grover, Gary Freedman & Samuel Swisher-McClure

  2. Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA

    Shahed N. Badiyan, Elizabeth Nichols & Steven J. Feigenberg

  3. Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA

    Daniel M. Trifiletti

  4. Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA

    Shayna L. Showalter

  5. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, T28, Cleveland, OH, 44195, USA

    Yvonne Pham, Aditya Juloori, Rahul Tendulkar & Chirag Shah

  6. 21st Century Oncology, Michigan Healthcare Professionals, Farmington Hills, MI, USA

    Frank Vicini

Authors
  1. Surbhi Grover
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  2. Shahed N. Badiyan
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  3. Daniel M. Trifiletti
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  4. Shayna L. Showalter
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  5. Yvonne Pham
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  6. Frank Vicini
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  7. Aditya Juloori
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  8. Gary Freedman
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  9. Rahul Tendulkar
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  10. Samuel Swisher-McClure
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  11. Elizabeth Nichols
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  12. Steven J. Feigenberg
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  13. Chirag Shah
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Corresponding author

Correspondence to Chirag Shah.

Ethics declarations

Funding source

No funding support is associated with this study.

Conflict of interest

Dr. Grover declares that she has no conflict of interest. Dr. Badiyan declares that he has no conflict of interest. Dr. Trifiletti declares that he has no conflict of interest. Dr. Showalter declares that she has no conflict of interest. Dr. Pham declares that she has no conflict of interest. Dr. Vicini declares that he has no conflict of interest. Dr. Juloori declares that he has no conflict of interest. Dr. Freedman declares that he has no conflict of interest. Dr. Tendulkar declares that he has no conflict of interest. Dr. Swisher-McClure declares that he has no conflict of interest. Dr. Nichols declares that she has no conflict of interest. Dr. Feigenberg declares that he has no conflict of interest. Dr. Shah declares that he is a consultant for Impedimed.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required.

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Grover, S., Badiyan, S.N., Trifiletti, D.M. et al. Regional nodal irradiation following pathologic complete response in the axilla to neoadjuvant chemotherapy: patterns of treatment. J Radiat Oncol 6, 81–92 (2017). https://doi.org/10.1007/s13566-016-0290-3

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  • DOI: https://doi.org/10.1007/s13566-016-0290-3

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