Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy
Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy
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DOI：
10.1200/jco.2004.11.129
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发表时间：
2004-12-01
影响因子：
45.3
通讯作者：
Buchholz, TA
中科院分区：
文献类型：
--
作者：
Huang, EH;Tucker, SL;Buchholz, TA
目的评价放疗在新辅助化疗和乳房切除术患者中的疗效。患者和方法我们回顾性分析了542例接受新辅助化疗、乳房切除术和放疗的患者在6个连续的前瞻性研究中的结果。这些数据进行了比较，134例患者接受类似的治疗，在这些相同的试验，但没有radiation.Results照射的患者有较低的局部区域复发率（LRR）（10年率：11% V 22%，P = 0.0001）。对于临床T3或T4肿瘤、分期大于或等于IIB疾病（AJCC 1988）、病理肿瘤大小>2 cm或4个或更多阳性淋巴结的患者，放射降低了LRR（所有比较的P小于或等于0.002）。临床晚期III期或IV期疾病但随后对新辅助化疗达到病理完全缓解的患者仍有较高的LRR率，放射治疗显著降低（10年率：33% vs 3%，P = 0.006）。放射治疗改善了以下亚组的病因特异性生存率（CSS）：大于或等于IIIB期疾病，临床T4肿瘤，以及4个或更多阳性淋巴结（所有比较的P小于或等于0.007）。在LRR和CSS的多变量分析中，缺乏辐射的风险比为4.7（95% CI，2.7 - 8.1; P < .0001）和2.0（95% Cl，1.4 ~ 2.9;结论新辅助化疗联合乳腺癌根治术后，对于临床T3期或III-IV期肿瘤患者，发现综合放疗有利于局部控制和生存（同侧锁骨上淋巴结）疾病和具有四个或更多个阳性淋巴结的患者。无论这些患者对初始化疗的反应如何，都应考虑放射治疗。(C)2004年，美国临床肿瘤学会。
Purpose To evaluate the efficacy of radiation in patients treated with neoadjuvant chemotherapy and mastectomy.Patients and Methods We retrospectively analyzed the outcomes of 542 patients treated on six consecutive institutional prospective trials with neoadjuvant chemotherapy, mastectomy, and radiation. These data were compared to those of 134 patients who received similar treatment in these same trials but without radiation.Results Irradiated patients had a lower rate of local-regional recurrence (LRR) (10-year rates: 11% V 22%, P = .0001). Radiation reduced LRR for patients with clinical T3 or T4 tumors, stage greater than or equal to IIB disease (AJCC 1988), pathological tumor size >2 cm, or four or more positive nodes (P less than or equal to .002 for all comparisons). Patients who presented with clinically advanced stage III or IV disease but subsequently achieved a pathological complete response to neoadjuvant chemotherapy still had a high rate of LRR, which was significantly reduced with radiation (10-year rates: 33% v 3%, P = .006). Radiation improved cause-specific survival (CSS) in the following subsets: stage greater than or equal to IIIB disease, clinical T4 tumors, and four or more positive nodes (P less than or equal to .007 for all comparisons). On multivariate analyses of LRR and CSS, the hazard ratios for lack of radiation were 4.7 (95% Cl, 2.7 to 8.1; P < .0001) and 2.0 (95% Cl, 1.4 to 2.9; P < .0001), respectively.Conclusion After neoadjuvant chemotherapy and mastectomy, comprehensive radiation was found to benefit both local control and survival for patients presenting with clinical T3 tumors or stage III-IV (ipsilateral supraclavicular nodal) disease and for patients with four or more positive nodes. Radiation should be considered for these patients regardless of their response to initial chemotherapy. (C) 2004 by American Society of Clinical Oncology.