title: Preoperative concurrent paclitaxel-radiation in locally advanced breast cancer: pathologic response correlates with five-year overall survival.
abstract: We have previously demonstrated high pathologic response rates after neoadjuvant concurrent chemoradiation in patients with locally advanced breast cancer (LABC). We now report disease-free survival (DFS) and overall survival (OS) in the context of pathologic response. 105 LABC patients (White 46%, Non-White 54%) were treated with paclitaxel (30 mg/m² intravenously twice a week) for 10-12 weeks. Daily radiotherapy was delivered to breast, axillary, and supraclavicular lymph nodes during weeks 2-7 of paclitaxel treatment, at 1.8 Gy per fraction to a total dose of 45 Gy with a tumor boost of 14 Gy at 2 Gy/fraction. Pathological complete response (pCR) was defined as the absence of invasive cancer in breast and lymph nodes and pathological partial response (pPR) as the persistence of <10 microscopic foci of invasive carcinoma in breast or lymph nodes. Pathologic response (pCR and pPR) after neoadjuvant chemoradiation was achieved in 36/105 patients (34%) and was associated with significantly better DFS and OS. Pathological responders had a lower risk of recurrence or death (HR = 0.35, P = 0.01) and a longer OS (HR = 4.27, P = 0.01) compared with non-responders. Median DFS and OS were 57 and 84 months for non-responders, respectively, and have not yet been reached for responders. Importantly, pathologic response was achieved in 54% of patients with HR negative tumors (26/48). In conclusion, pathologic response to concurrent paclitaxel-radiation translated into superior DFS and OS. Half of the patients with HR negative tumors achieved a pathologic response.
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine, 160 E 34th Street, New York, NY, 10016, USA.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Adams
authors.forename: A Bapsi
authors.initials: AB
authors.lastname: Chakravarthy
authors.forename: Martin
authors.initials: M
authors.lastname: Donach
authors.forename: Darcy
authors.initials: D
authors.lastname: Spicer
authors.forename: Stella
authors.initials: S
authors.lastname: Lymberis
authors.forename: Baljit
authors.initials: B
authors.lastname: Singh
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Bauer
authors.forename: Tsivia
authors.initials: T
authors.lastname: Hochman
authors.forename: Judith D
authors.initials: JD
authors.lastname: Goldberg
authors.forename: Franco
authors.initials: F
authors.lastname: Muggia
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Schneider
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Pietenpol
authors.forename: Silvia C
authors.initials: SC
authors.lastname: Formenti
mesh_terms: D000328:Adult; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel