title: Preoperative radiotherapy in breast cancer patients: 32 years of follow-up.
abstract: This study evaluates the long-term outcomes of a retrospective cohort of breast cancer (BC) patients who had received curatively intended premastectomy radiation therapy (RT). We analysed locoregional control, disease-free survival (DFS) and overall survival (OS), pathological complete remission (pCR), predictors thereof, and immediate safety. The series consisted of 187 patients with a median age of 49 years [43-60] and T2-T4 or N2 tumours. Between 1970 and 1984, they had received slightly hypofractionated RT to the whole breast, ipsilateral supraclavicular fossa and axilla ± the internal mammary chain (45-55 Gy/18 fractions of 2.5 Gy/34 days) systematically followed by a modified radical mastectomy with an axillary dissection. No other preoperative treatment was given. Among the 166 centrally reviewed tumour biopsy specimens, 22% had a triple-negative (TN) phenotype, 17% were HER2 3 + or amplified and 61% were ER+. The median follow-up was 32 years [23-35]. The 25-year locoregional control rate was 89% [93%-82%] and the 25-year DFS and OS rates were identical, 30% [24%-37%]. A pCR in the tumour and lymph nodes had been achieved in 18 among all patients (10%), but in 26% with TN disease. In the multivariate analysis, the TN status was the only predictive factor of pCR (OR = 5.49, 95% confidence interval [CI] 1.87-16.1, p = 0.002). Also, the pN status (HR = 1.69, [1.28-2.22], p = 0.0002) and TN subtype (HR = 1.80, [1.00-3.26], p = 0.05) exerted a significant prognostic impact on OS. The postoperative complication rate (grade >2) was 19% with 4.3% of localized skin necrosis. Preoperative RT followed by radical surgery is feasible and associated with good long-term locoregional control.
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, Villejuif, France. Electronic address: francois.riet@gmail.com.
authors.forename: F G
authors.initials: FG
authors.lastname: Riet
authors.affiliation: Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France.
authors.forename: F
authors.initials: F
authors.lastname: Fayard
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, Villejuif, France; Radiumhemmet, Karolinska Institutet, Stockholm, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Arriagada
authors.affiliation: Department of Oncology, Brasília University Hospital, Brasilia, Brazil.
authors.forename: M A
authors.initials: MA
authors.lastname: Santos
authors.affiliation: Department of Radiation Oncology, ICM, Montpellier, France.
authors.forename: C
authors.initials: C
authors.lastname: Bourgier
authors.affiliation: Department of Biopathology, Gustave Roussy, Villejuif, France.
authors.forename: M
authors.initials: M
authors.lastname: Ferchiou
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, Villejuif, France.
authors.forename: S
authors.initials: S
authors.lastname: Heymann
authors.affiliation: Department of Medical Oncology, Gustave Roussy, Villejuif, France.
authors.forename: S
authors.initials: S
authors.lastname: Delaloge
authors.affiliation: Department of Surgery, Gustave Roussy, Villejuif, France.
authors.forename: C
authors.initials: C
authors.lastname: Mazouni
authors.affiliation: Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Dunant
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, Villejuif, France.
authors.forename: S
authors.initials: S
authors.lastname: Rivera
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018275:Carcinoma, Lobular / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018276:Carcinoma, Medullary / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D011878:Radiotherapy; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D064726:Triple Negative Breast Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; C508053:ERBB2 protein, human
keywords: Breast cancer; Hypofractionated radiation therapy; Pathological complete response; Preoperative radiation therapy; Triple-negative tumours