Locoregional Recurrence Risk in Breast Cancer Patients with Estrogen Receptor Positive Tumors and Residual Nodal Disease following Neoadjuvant Chemotherapy and Mastectomy without Radiation Therapy.
Among breast cancer patients treated with neoadjuvant chemotherapy (NAC) and mastectomy, locoregional recurrence (LRR) rates are unclear in women with ER+ tumors treated with adjuvant endocrine therapy without postmastectomy radiation (PMRT). To determine if PMRT is needed in these patients, we compared LRR rates of patients with ER+ tumors (treated with adjuvant endocrine therapy) with women who have non-ER+ tumors. 85 consecutive breast cancer patients (87 breast tumors) treated with NAC and mastectomy without PMRT were reviewed. Patients were divided by residual nodal disease (ypN) status (ypN+ versus ypN0) and then stratified by receptor subtype. Among ypN+ patients (n = 35), five-year LRR risk in patients with ER+, Her2+, and triple negative tumors was 5%, 33%, and 37%, respectively (p = 0.02). Among ypN+/ER+ patients, lymphovascular invasion and grade three disease increased the five-year LRR risk to 13% and 11%, respectively. Among ypN0 patients (n = 52), five-year LRR risk in patients with ER+, Her2+, and triple negative tumors was 7%, 22%, and 6%, respectively (p = 0.71). In women with ER+ tumors and residual nodal disease, endocrine therapy may be sufficient adjuvant treatment, except in patients with lymphovascular invasion or grade three tumors where PMRT may still be indicated.
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA ; Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA.
Shravan
S
Kandula
Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA 30322, USA.
Jeffrey M
JM
Switchenko
Department of Pathology, Emory University, Atlanta, GA 30322, USA.
Saul
S
Harari
Department of Radiation Oncology, Stanford Medical Center, Stanford, CA 94305, USA.
Carolina
C
Fasola
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA ; Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA.
Donna
D
Mister
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA ; Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA.
David S
DS
Yu
Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA ; Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA.
Amelia B
AB
Zelnak
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA ; Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA.
Mylin A
MA
Torres