Purpose:
This retrospective study compares patients treated between 1991 and 1998 with neoadjuvant radiotherapy ± chemotherapy (RCT) or adjuvant RCT for locally advanced noninflammatory breast cancers (LABC) in terms of pathologic complete response (pCR), 10-year relapse-free (RFS), and overall survival (OS).
Patients and Methods:
Preoperative RCT in 315 and adjuvant RCT in 329 cases consisted in 50 Gy (5 × 2 Gy/week) to the breast and the supra-/infraclavicular lymph nodes. 101 neoadjuvant patients received – in case of breast conservation – a 10-Gy interstitial boost with 192Ir afterloading before and 214 neoadjuvant patients a preoperative electron boost after external-beam radiotherapy. In the neoadjuvant RCT group, chemotherapy was applied prior to radiotherapy in 192 patients, and simultaneously in 113; ten had no chemotherapy. In the adjuvant RCT group, chemotherapy was applied to 44 patients before surgery and to 166 after surgery; 119 had no chemotherapy.
Results:
Breast conservation became possible in 50.8% after neoadjuvant RCT for LABC with a pCR rate at surgery of 29.2%. A complete nodal remission (pN0) after RCT was observed in 56% (89/159) of the cN+ (clinically node-positive) neoadjuvant patients. There were trends in favor of preoperative RCT for RFS and OS (hazard ratio [HR] = 0.85; p = 0.09 for RFS; HR = 0.8130; p = 0.1037 for OS). For patients with cT2 tumors the RFS and OS were statistically significantly better (HR = 0.5090; p = 0.0130 for RFS; HR = 0.4390; p = 0.0026 for OS) after neoadjuvant compared to adjuvant RCT.
Conclusion:
Neoadjuvant RCT achieved a pCR rate of 29.2% and a statistically significantly better RFS and OS in patients with cT2-category breast cancer.
Ziel:
Die Studie untersucht retrospektiv die Daten von Patientinnen, die in den Jahren 1991–1998 wegen eines lokal fortgeschrittenen, nichtinflammatorischen Mammakarzinoms (LABC) behandelt wurden. Verglichen werden eine neoadjuvante Strahlentherapie ± Chemotherapie (RCT) mit einer adjuvanten RCT hinsichtlich der pathologisch kompletten Remission (pCR), der 10-Jahres-Erkrankungsfreiheit (RFS) und des Gesamtüberlebens (OS).
Patienten und Methodik:
Bei 315 Patientinnen mit einer praoperativen RCT und bei 329 Patientinnen mit einer adjuvanten RCT wurden 50 Gy (5 × 2 Gy/Woche) auf die Brust und die supra-/infraklavikularen Lymphknoten appliziert. 101 neoadjuvante Patientinnen erhielten im Fall einer Brusterhaltung einen interstitiellen 10-Gy-Boost mit 192Ir-Afterloading vor und 214 neoadjuvante Patientinnen einen 10-Gy-Elektronenboost nach externer Strahlentherapie. Die Chemotherapie wurde in der neoadjuvanten RCT-Gruppe bei 192 Patientinnen vor der Strahlentherapie und bei 113 simultan appliziert. Zehn Patientinnen erhielten keine Chemotherapie. In der adjuvanten RCT-Gruppe wurde die Chemotherapie vor der Operation bei 44 und nach der Operation bei 166 Patientinnen appliziert. 119 Patientinnen erhielten keine Chemotherapie.
Ergebnisse:
Die neoadjuvante RCT ermöglichte bei 50,8% der Patientinnen eine Brusterhaltung. Die lokale und gleichzeitig auch regionale komplette Remissionsrate (pCR) betrug 29,2%. Durch die neoadjuvante RCT konnte bei 56% (89/159) der cN+ neoadjuvanten Patienten ein pN0 erzielt werden. Im Gesamtkollektiv war zwar die neoadjuvante der adjuvanten Therapie hinsichtlich RFS und OS nur tendenziell überlegen (Hazard-Ratio [HR] = 0,85; p = 0,09 fur RFS; HR = 0,8130; p = 0,1037 fur OS), bei Patientinnen mit einer cT2-Kategorie erwiesen sich jedoch RFS und OS nach einer neoadjuvant RCT als signifikant besser als nach einer adjuvanten RCT (HR = 0,5090; p = 0,0130 fur RFS; HR = 0,4390; p = 0,0026 fur OS).
Schlussfolgerung:
Eine neoadjuvante RCT erzielte eine Brusterhaltung bei 50,8% der LABC, eine pCR-Rate von 29,2% und bei cN+ eine pN0-Rate von 56%. Bei Patientinnen mit einer cT2-Kategorie waren RFS und OS nach einer neoadjuvanten versus einer adjuvanten RCT statistisch signifikant überlegen.
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*Presented at the 2009 ASCO Annual Meeting, Orlando, FL, USA [26].
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Roth, S.L., Audretsch, W., Bojar, H. et al. Retrospective Study of Neoadjuvant Versus Adjuvant Radiochemotherapy in Locally Advanced Noninflammatory Breast Cancer. Strahlenther Onkol 186, 299–306 (2010). https://doi.org/10.1007/s00066-010-2143-0
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DOI: https://doi.org/10.1007/s00066-010-2143-0