Relationship of omission of adjuvant radiotherapy to outcomes of locoregional control and disease-free survival in patients with or without pCR after neoadjuvant chemotherapy for breast cancer

• Verfasst von: Krug, David [VerfasserIn]
• Verfasst von: Lederer, Bianca [VerfasserIn]
• Verfasst von: Debus, Jürgen [VerfasserIn]
• Verfasst von: Blohmer, Jens-Uwe [VerfasserIn]
• Verfasst von: Costa, Serban Dan [VerfasserIn]
• Verfasst von: Eidtmann, Holger [VerfasserIn]
• Verfasst von: Hanusch, Claus Alexander [VerfasserIn]
• Verfasst von: Hilfrich, Jörn [VerfasserIn]
• Verfasst von: Huober, Jens [VerfasserIn]
• Verfasst von: Jackisch, Christian [VerfasserIn]
• Verfasst von: Kümmel, Sherko [VerfasserIn]
• Verfasst von: Paepke, Stefan [VerfasserIn]
• Verfasst von: Schneeweiss, Andreas [VerfasserIn]
• Verfasst von: Untch, Michael [VerfasserIn]
• Verfasst von: Minckwitz, Gunter von [VerfasserIn]
• Verfasst von: Loibl, Sibylle [VerfasserIn]
• Titel: Relationship of omission of adjuvant radiotherapy to outcomes of locoregional control and disease-free survival in patients with or without pCR after neoadjuvant chemotherapy for breast cancer
• Titelzusatz: a meta-analysis on 3481 patients from the Gepar-trials
• Verf.angabe: David Krug, Bianca Lederer, Juergen Debus, Jens Uwe Blohmer, Serban Dan Costa, Holger Eidtmann, Claus Hanusch, Joern Hilfrich, Jens Bodo Huober, Christian Jackisch, Sherko Kümmel, Stefan Paepke, Andreas Schneeweiss, Michael Untch, Gunter Von Minckwitz, Sibylle Loibl
• E-Jahr: 2017
• Jahr: January 31, 2017
• Jahr des Originals: 2015
• Umfang: 1 S.
• Fussnoten: Gesehen am 01.04.2020
• Titel Quelle: Enthalten in: Journal of clinical oncology
• Ort Quelle: Alexandria, Va. : American Society of Clinical Oncology, 1983
• Jahr Quelle: 2015
• Band/Heft Quelle: 33(2015), 15, Suppl, Seite 1008-1008
• ISSN Quelle: 1527-7755
• DOI: doi:10.1200/jco.2015.33.15_suppl.1008
• Datenträger: Online-Ressource
• Sprache: eng
• Bibliogr. Hinweis: Erscheint auch als : Druck-AusgabeKrug, David: Relationship of omission of adjuvant radiotherapy to outcomes of locoregional control and disease-free survival in patients with or without pCR after neoadjuvant chemotherapy for breast cancer. - 2015
• K10plus-PPN: 1693699850

Abstract

1008 Background: There is controversy whether the response to neoadjuvant chemotherapy should be incorporated into the decision-making process for adjuvant radiotherapy in breast cancer. Methods: We presenta pooled analysis of the randomized neoadjuvant trials GeparTrio, GeparQuattro and GeparQuinto including 3,481 patients with operable and non-operable breast cancer for which information on the use of radiotherapy (RT) was available. 94% received any RT. Locoregional recurrence was defined as a recurrence in the breast, at the chest wall or in the regional lymph nodes. Results: Patients in the RT-group were older and received more mastectomies. Their tumors were more likely to be HER2-positive and there was a higher rate of pathologic complete response (pCR, ypT0 ypN0). The overall risk of locoregional recurrence (LR) was 8.3% after a median follow-up of 55.9 months. RT conferred a significant benefit in terms of 5-year LR-free survival (LRFS, 90% vs. 81.5% without RT, logrank p < 0.001) and 5-year disease-free survival (DFS, 75.4% vs. 67.4%, logrank p < 0.001). The absolute advantage of RT regarding both LRFS and DFS was highest among patients with clinically positive lymph nodes at first diagnosis (HR 2.32, 95% CI 1.54-3.50; p < 0.001; HR 1.97, 95% CI 1.48-2.62; p < 0.001 respectively). In patients with pCR, the 5-yr LRFS was 95.7%% with RT vs 86.6% without RT (HR 3.32, 95% CI 1.00-11.08; p = 0.051) and 5-yr DFS was 86.9% and 56.1% (HR 3.52, 95% CI 1.82-6.83; p < 0.001). In patients without pCR, the LRFS was 88.6% with RT vs 80.7% without RT (HR 1.86, 95% CI 1.29-2.67; p < 0.001) and 5-yr DFS was 72.6% vs 65.7%; HR 1.39, 95% CI 1.07-1.81; p = 0.014). Multivariate analyses with adjustment for baseline parameters as well as for pathologic tumor stage and pCR confirmed RT as an independent prognostic factor for LRFS (HR 0.54, 95% CI 0.35-0.82; p = 0.004) and DFS (HR 0.69, 95% CI 0.51-0.93; p = 0.016). Conclusions: This retrospective analysis suggests thatpatients managed withoutRT after neoadjuvant chemotherapy for breast cancer have a significantly worse outcome even if they achieved a pCR.