title: Post-mastectomy radiation therapy and overall survival after neoadjuvant chemotherapy.
abstract: BACKGROUND
  The role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) and mastectomy is unclear, especially in patients that have post-treatment tumor negative axillary nodes (ypN0).
  
  
  METHODS
  The National Cancer Data Base was used to identify women that had PMRT after NAC and mastectomy for clinically node positive (cN1-2) disease from 2004 to 2008. Median follow-up time was 69 months.
  
  
  RESULTS
  8,321 patients were included for analysis, and 6140 (65.6%) had cN1 disease and 2181 (23.3%) had cN2 disease. On adjusted survival analysis, PMRT was associated with an overall survival (OS) benefit in both patients with cN1 (5-yr OS 75.8% vs. 71.9%, P < 0.01) and cN2 (5-yr OS 69.2% vs. 58.6%, P < 0.01) disease. In the subgroup of patients that were ypN0 after NAC, there was no significant survival difference (P > 0.11) for PMRT compared to those patients who were not ypN0, except for patients with hormone-receptor negative tumors, who had improved OS with PMRT (HR 0.65, P < 0.01).
  
  
  CONCLUSIONS
  PMRT is associated with improved OS in patients with cN1 and cN2 disease after NAC and mastectomy. However, in the subgroup of patients that were ypN0 after NAC, PMRT improved OS for hormone-receptor negative patients but not hormone-receptor positive patients.
authors.affiliation: Department of Surgery, University of Chicago, Chicago, Illinois.
authors.forename: Olga
authors.initials: O
authors.lastname: Kantor
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pesce
authors.affiliation: Department of Surgery, University of Chicago, Chicago, Illinois.
authors.forename: Puneet
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Surgery, University of Chicago, Chicago, Illinois.
authors.forename: Megan
authors.initials: M
authors.lastname: Miller
authors.affiliation: Department of Surgery, University of Chicago, Chicago, Illinois.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tseng
authors.affiliation: Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois.
authors.forename: Chi-Hsiung
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.
authors.forename: David J
authors.initials: DJ
authors.lastname: Winchester
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.
authors.forename: Katharine
authors.initials: K
authors.lastname: Yao
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D059248:Chemoradiotherapy / Q000706:statistics & numerical data; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000706:statistics & numerical data; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: breast cancer; neoadjuvant chemotherapy; postmastectomy radiation therapy