- The role of postmastectomy radiation in patients with ypN0 breast cancer after neoadjuvant chemotherapy: a meta- analysis. - Background: It has been demonstrated that postmastectomy radiation therapy (PMRT) was beneficial for breast cancer patients who are axillary lymph node-positive. - 95% CI P = 0.007), particularly in patients with stage III breast cancer (RR, 0.16. - The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. - If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. - Neoadjuvant chemotherapy (NAC) is increasingly used in locally advanced breast cancer. - In the adjuvant setting, postmastectomy radiation therapy (PMRT) have shown significantly reduces recurrence in patients with positive lymph nodes after following systemic treatment [3–5].. - However, the discrepancy in the response to NAC complicates the adjuvant setting treatment decision, and therefore, the role of PMRT in breast cancer with no evidence of residual pathologic nodal disease (ypN0) has remained controversial.. - Recently, several retrospective studies found that PMRT was associated with improving both local control and survival in ypN0 breast cancer patients [6–8]. - Subgroup analysis fur- ther confirmed a significant survival benefit in patients with cT1-2 N1 breast cancer. - However, other retrospect- ive data showed that patients with pathologically node- negative (ypN0) disease after NAC had smaller absolute rates of 5-year local-regional recurrence (LRR) (8% in the PMRT group vs. - 12% in the non-PMRT group) [10].. - The results implied that there was no increase in the risk of LRR when PMRT was omitted.. - In this systematic review and meta-analysis, literature in the PubMed database and major oncology congress ab- stracts were searched in June 2019, and the following search terms were variably combined: “breast cancer,”. - As some trials concerning NAC and breast cancer prognosis may not have yet been published, we searched for relevant abstracts published in major international proceedings.. - Histo- logical type and breast cancer status were not restricted.. - The relevant information was carefully extracted according to the following three aspects: (1) PMRT was correlated with LRR in breast cancer and subgroup. - Wang et al. - Impact of PMRT on LRR in patients with ypN0 breast cancer. - We evaluated the association between PMRT and LRR in the entire group and in subgroups to determine their contribution.. - Among those patients with ypN0 breast cancer, the estimated pooled RR for all studies showed that PMRT significantly reduced LRR in patients compared with those in the non-PMRT group (RR, 0.38. - The funnel plot and Egger’s test indicated that slight asymmetry in the presence of publication bias of the included literature. - Table 1 Selected characteristics of studies in the meta-analysis. - 0.001) in patients with less than stage III disease (Fig. - Among those with stage III breast cancer, the LRR rate was also significantly re- duced for breast cancer patients in the PMRT group compared with those in the non-PMRT group (RR, 0.16;. - Effects of PMRT on disease free survival (DFS) in patients with ypN0 breast cancer. - The estimated pooled RR in the PMRT group was not associated with a high DFS rate compared. - with patients in the non-PMRT group (RR, 0.70. - Effects of PMRT on overall survival (OS) in patients with ypN0 breast cancer. - PMRT impact on OS was available in nine ypN0 breast cancer studies. - 3B) in patients in the PMRT group compared with those in the non-PMRT group.. - Currently, there are no published randomized trials to guide the impact of PMRT on breast cancer patients treated with NAC, particularly in patients who are ypN0 and in whom the advantage of PMRT is not known. - B Stage less than III breast cancer. - C Stage III breast cancer. - postmastectomy radiation therapy. - of PMRT in breast cancer patients who received NAC.. - We confirmed that radiation could reduce the LRR rate (P = 0.007), particularly in patients with stage III breast cancer (P <. - In contrast, DFS (P = 0.55) and OS (P = 0.10) wasn’t significantly improved in the PMRT compared with the non-PMRT group. - It was not surprising that the benefits of PMRT in the current study were similar to those reported after adjuvant chemotherapy [8, 22].. - A retrospective study revealed that in patients receiving primary systemic treatment and mast- ectomy, there was a significant reduction in the 5-year. - LRR rate in the PMRT group (24% vs. - 0.001) after a median of 75 months of follow-up in 162 patients with ypN0 breast cancer [21]. - In our analysis, the data also evaluated the benefit derived from PMRT in pa- tients receiving NAC and mastectomy for their locally advanced breast cancer. - Another major concern is whether PMRT improves survival outcomes in patients with ypN0 breast cancer after NAC. - Recent retrospective data from Korea showed that PMRT was not associated with a difference in DFS or OS for patients with clinical stage II-III breast cancer who were ypN0 [15]. - The present meta-analysis confirmed that PMRT did not improve DFS or OS in patients with ypN0 breast cancer who received PMRT following primary systemic treatment. - The analysis showed that patients with PMRT were no correlation with a difference in DFS and OS. - It could re- duce breast cancer mortality in patients with clinically lymph node-positive disease. - Moreover, molecular typing of triple negativity is a significantly worse survival rate than patients with other subtypes. - First, despite knowing the clinical disease stage before NAC, there may be other factors such as ER/PR status or patho- logic stage after NAC that could influence patient se- lection for PMRT among those with ypN0 breast cancer. - In summary, our results strongly suggest that PMRT is as- sociated with reduced LRR, particularly in stage III breast cancer patients. - However, PMRT was not associated with improved survival benefit among those with ypN0 breast cancer after NAC. - A prospective randomized study, such as the ongoing NSABP B-51/RTOG 1304 trial (Clinical- Trials.gov, NCT01872975), will be needed to confirm our results and serve as guidance for selecting the optimal radiotherapy regimen for ypN0 breast cancer patients.. - org/10.1186/s . - (A) Stage I-II breast cancer. - (B) Stage III breast cancer. - Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. - https://doi.org/1 0.1200/JCO . - Recommendations from an international consensus conference on the current status and future of neoadjuvant systemic therapy in primary breast cancer. - https://doi.org/10.1245/s . - Ebctcg, McGale P, Taylor C, Correa C, Cutter D, Duane F, et al. - Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. - Postmastectomy radiation in breast cancer patients with pathologically positive lymph nodes after neoadjuvant chemotherapy: usage rates and survival trends. - https://doi.. - The impact of the size of nodal metastases on recurrence risk in breast cancer patients with 1-3 positive axillary nodes after mastectomy. - https://doi.org/10.1016/j.ijrobp . - The role of postmastectomy radiation therapy in patients with breast cancer responding to neoadjuvant chemotherapy.. - https://doi.org/10.1016/j.semradonc . - Role of postmastectomy radiation therapy after neoadjuvant chemotherapy in locally advanced breast cancer. - Role of postmastectomy radiation after neoadjuvant chemotherapy in stage II-III breast cancer. - The impact of postmastectomy and regional nodal radiation after neoadjuvant chemotherapy for clinically lymph node-positive breast cancer:. - https://doi.org/10.1093/annonc/mdw046.. - Radiotherapy for stage II and stage III breast cancer patients with negative lymph nodes after preoperative chemotherapy and mastectomy. - https://doi.org/10.1002/(SICI . - Huang EH, Tucker SL, Strom EA, McNeese MD, Kuerer HM, Buzdar AU, et al.. - Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy. - https://doi.org/10.1200/JCO . - Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy. - Bae SH, Park W, Huh SJ, Choi DH, Nam SJ, Im YH, et al. - Radiation treatment in pathologic n0-n1 patients treated with neoadjuvant chemotherapy followed by surgery for locally advanced breast cancer. - J Breast Cancer.. - https://doi.org/10.4048/jbc . - Shim SJ, Park W, Huh SJ, Choi DH, Shin KH, Lee NK, et al. - The role of postmastectomy radiation therapy after neoadjuvant chemotherapy in clinical stage II-III breast cancer patients with pN0: a multicenter, retrospective study (KROG 12-05). - The role of postmastectomy radiotherapy in clinically node-positive, stage II-III breast cancer patients with pathological negative nodes after neoadjuvant chemotherapy: an analysis from the NCDB. - https://doi.org/10.18632/oncotarget.6664.. - The role of postmastectomy radiotherapy in clinical T1 – 3N1M0 breast cancer patients with pathological negative lymph nodes after neoadjuvant chemotherapy and mastectomy. - https://doi.org/10.1002/jso.24551.. - postmastectomy radiotherapy after primary systemic treatment in patients with clinical T1-2N1 breast cancer. - https://doi.org/10.1016/j.canrad . - Role of postmastectomy radiotherapy after neoadjuvant chemotherapy in breast cancer patients: a study from the Japanese breast cancer registry. - org/10.1245/s . - Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. - Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al.. - Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. - Danish Breast Cancer Cooperative Group 82b Trial. - Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, et al. - Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. - https://doi.org/1 0.1016/S . - Local- regional recurrence with and without radiation therapy after neoadjuvant chemotherapy and mastectomy for clinically staged T3N0 breast cancer
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