title: Postmastectomy radiotherapy for locally advanced breast cancer receiving neoadjuvant chemotherapy.
abstract: Neoadjuvant chemotherapy (NAC) is widely used in locally advanced breast cancer (BC) treatment. The role of postmastectomy radiotherapy (PMRT) after NAC is strongly debated. The aim of our analysis was to identify major prognostic factors in a single-center series, with emphasis on PMRT. From 1997 to 2011, 170 patients were treated with NAC and mastectomy at our center; 98 cases (57.6%) underwent PMRT and 72 cases (42.4%) did not receive radiation. At a median follow-up period of 7.7 years (range 2-16) for the whole cohort, median time to locoregional recurrence (LRR) was 3.3 years (range 0.7-12.4). The 5-year and 10-year actuarial LRR rate were 14.5% and 15.9%, respectively. At the multivariate analysis the factors that significantly correlated with survival outcome were ≥ 4 positive nodes (HR 5.0, 1.51-16.52; P = 0.035), extracapsular extension (HR 2.18, 1.37-3.46; P = 0.009), and estrogen receptor positive disease (HR 0.57, 0.36-0.90; P = 0.003). Concerning LRR according to use of radiation, PMRT reduced LRR for patient with clinical T3 staged disease (P = 0.015). Our experience confirmed the impact of pathological nodal involvement on survival outcome. PMRT was found to improve local control in patients presenting with clinical T3 tumors, regardless of the response to chemotherapy.
authors.affiliation: Department of Radiation-Oncology, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Icro
authors.initials: I
authors.lastname: Meattini
authors.affiliation: Department of Radiation-Oncology, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Sara
authors.identifier: 0000-0003-4737-4029
authors.initials: S
authors.lastname: Cecchini
authors.affiliation: Department of Radiation-Oncology, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Di Cataldo
authors.affiliation: Molecular and Nutritional Epidemiology Unit, ISPO (Cancer Research and Prevention Institute), University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Saieva
authors.affiliation: Department of Radiation-Oncology, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Francolini
authors.affiliation: Department of Radiation-Oncology, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Vieri
authors.initials: V
authors.lastname: Scotti
authors.affiliation: Department of Radiation-Oncology, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Bonomo
authors.affiliation: Department of Radiation-Oncology, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Mangoni
authors.affiliation: Department of Radiation-Oncology, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Greto
authors.affiliation: Diagnostic Senology Unit, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Nori
authors.affiliation: Department of Surgery, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Orzalesi
authors.affiliation: Department of Surgery, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Casella
authors.affiliation: Department of Surgery, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Simoncini
authors.affiliation: Department of Gynecology and Obstetrics, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fambrini
authors.affiliation: Department of Pathology, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Bianchi
authors.affiliation: Department of Radiation-Oncology, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Livi
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D009367:Neoplasm Staging