Role of Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer Patients

A Study from the Japanese Breast Cancer Registry

Minoru Miyashita, Naoki Niikura, Hiraku Kumamaru, Hiroaki Miyata, Takayuki Iwamoto, Masaaki Kawai, Keisei Anan, Naoki Hayashi, Kenjiro Aogi, Takanori Ishida, Hideji Masuoka, Kotaro Iijima, Shinobu Masuda, Koichiro Tsugawa, Takayuki Kinoshita, Hitoshi Tsuda, Seigo Nakamura, Yutaka Tokuda

Research output: Contribution to journalArticle

Abstract

Background: The role of postmastectomy radiotherapy (PMRT) in breast cancer patients receiving neoadjuvant chemotherapy (NAC) is controversial. We aimed to evaluate the effectiveness of radiotherapy in patients treated with NAC and mastectomy in the Japanese Breast Cancer Registry. Methods: We enrolled patients who received NAC and mastectomy for cT1–4 cN0–2 M0 breast cancer. We evaluated the association between radiotherapy and outcomes, locoregional recurrence (LRR), distant disease-free survival (DDFS), and overall survival (OS) based on ypN status by multivariable analysis. Results: Of the 145,530 patients, we identified 3226 who met the inclusion criteria. Among ypN1 patients, no differences were found in LRR, DDFS, or OS between groups with and without radiotherapy (p = 0.72, p = 0.29, and p = 0.36, respectively). Radiotherapy was associated with improved LRR-free survival (p < 0.001), DDFS (p = 0.01), and OS (p < 0.001) in patients with ypN2–3. Multivariable analysis demonstrated that use of radiotherapy was independently associated with improved LRR [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.45–0.82, p = 0.001] and OS [HR 0.69, 95% CI 0.53–0.89, p = 0.004) for ypN2–3 patients only. The association between radiotherapy and OS was not statistically significant among ypN0 (p = 0.22) and ypN1 patients (p = 0.51). Conclusions: The results from this nationwide database study did not show significant associations between PMRT and improved survival among ypN0 and ypN1 patients. Radiotherapy may be beneficial only for ypN2–3 breast cancer patients who receive NAC and mastectomy in the modern era.

Original languageEnglish
JournalAnnals of Surgical Oncology
DOIs
Publication statusPublished - 2019 Jan 1

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Registries
Radiotherapy
Breast Neoplasms
Drug Therapy
Survival
Mastectomy
Disease-Free Survival
Recurrence
Confidence Intervals
Databases

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Role of Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer Patients : A Study from the Japanese Breast Cancer Registry. / Miyashita, Minoru; Niikura, Naoki; Kumamaru, Hiraku; Miyata, Hiroaki; Iwamoto, Takayuki; Kawai, Masaaki; Anan, Keisei; Hayashi, Naoki; Aogi, Kenjiro; Ishida, Takanori; Masuoka, Hideji; Iijima, Kotaro; Masuda, Shinobu; Tsugawa, Koichiro; Kinoshita, Takayuki; Tsuda, Hitoshi; Nakamura, Seigo; Tokuda, Yutaka.

In: Annals of Surgical Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Miyashita, M, Niikura, N, Kumamaru, H, Miyata, H, Iwamoto, T, Kawai, M, Anan, K, Hayashi, N, Aogi, K, Ishida, T, Masuoka, H, Iijima, K, Masuda, S, Tsugawa, K, Kinoshita, T, Tsuda, H, Nakamura, S & Tokuda, Y 2019, 'Role of Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer Patients: A Study from the Japanese Breast Cancer Registry', Annals of Surgical Oncology. https://doi.org/10.1245/s10434-019-07453-1
Miyashita, Minoru ; Niikura, Naoki ; Kumamaru, Hiraku ; Miyata, Hiroaki ; Iwamoto, Takayuki ; Kawai, Masaaki ; Anan, Keisei ; Hayashi, Naoki ; Aogi, Kenjiro ; Ishida, Takanori ; Masuoka, Hideji ; Iijima, Kotaro ; Masuda, Shinobu ; Tsugawa, Koichiro ; Kinoshita, Takayuki ; Tsuda, Hitoshi ; Nakamura, Seigo ; Tokuda, Yutaka. / Role of Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer Patients : A Study from the Japanese Breast Cancer Registry. In: Annals of Surgical Oncology. 2019.
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abstract = "Background: The role of postmastectomy radiotherapy (PMRT) in breast cancer patients receiving neoadjuvant chemotherapy (NAC) is controversial. We aimed to evaluate the effectiveness of radiotherapy in patients treated with NAC and mastectomy in the Japanese Breast Cancer Registry. Methods: We enrolled patients who received NAC and mastectomy for cT1–4 cN0–2 M0 breast cancer. We evaluated the association between radiotherapy and outcomes, locoregional recurrence (LRR), distant disease-free survival (DDFS), and overall survival (OS) based on ypN status by multivariable analysis. Results: Of the 145,530 patients, we identified 3226 who met the inclusion criteria. Among ypN1 patients, no differences were found in LRR, DDFS, or OS between groups with and without radiotherapy (p = 0.72, p = 0.29, and p = 0.36, respectively). Radiotherapy was associated with improved LRR-free survival (p < 0.001), DDFS (p = 0.01), and OS (p < 0.001) in patients with ypN2–3. Multivariable analysis demonstrated that use of radiotherapy was independently associated with improved LRR [hazard ratio (HR) 0.61, 95{\%} confidence interval (CI) 0.45–0.82, p = 0.001] and OS [HR 0.69, 95{\%} CI 0.53–0.89, p = 0.004) for ypN2–3 patients only. The association between radiotherapy and OS was not statistically significant among ypN0 (p = 0.22) and ypN1 patients (p = 0.51). Conclusions: The results from this nationwide database study did not show significant associations between PMRT and improved survival among ypN0 and ypN1 patients. Radiotherapy may be beneficial only for ypN2–3 breast cancer patients who receive NAC and mastectomy in the modern era.",
author = "Minoru Miyashita and Naoki Niikura and Hiraku Kumamaru and Hiroaki Miyata and Takayuki Iwamoto and Masaaki Kawai and Keisei Anan and Naoki Hayashi and Kenjiro Aogi and Takanori Ishida and Hideji Masuoka and Kotaro Iijima and Shinobu Masuda and Koichiro Tsugawa and Takayuki Kinoshita and Hitoshi Tsuda and Seigo Nakamura and Yutaka Tokuda",
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T1 - Role of Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer Patients

T2 - A Study from the Japanese Breast Cancer Registry

AU - Miyashita, Minoru

AU - Niikura, Naoki

AU - Kumamaru, Hiraku

AU - Miyata, Hiroaki

AU - Iwamoto, Takayuki

AU - Kawai, Masaaki

AU - Anan, Keisei

AU - Hayashi, Naoki

AU - Aogi, Kenjiro

AU - Ishida, Takanori

AU - Masuoka, Hideji

AU - Iijima, Kotaro

AU - Masuda, Shinobu

AU - Tsugawa, Koichiro

AU - Kinoshita, Takayuki

AU - Tsuda, Hitoshi

AU - Nakamura, Seigo

AU - Tokuda, Yutaka

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The role of postmastectomy radiotherapy (PMRT) in breast cancer patients receiving neoadjuvant chemotherapy (NAC) is controversial. We aimed to evaluate the effectiveness of radiotherapy in patients treated with NAC and mastectomy in the Japanese Breast Cancer Registry. Methods: We enrolled patients who received NAC and mastectomy for cT1–4 cN0–2 M0 breast cancer. We evaluated the association between radiotherapy and outcomes, locoregional recurrence (LRR), distant disease-free survival (DDFS), and overall survival (OS) based on ypN status by multivariable analysis. Results: Of the 145,530 patients, we identified 3226 who met the inclusion criteria. Among ypN1 patients, no differences were found in LRR, DDFS, or OS between groups with and without radiotherapy (p = 0.72, p = 0.29, and p = 0.36, respectively). Radiotherapy was associated with improved LRR-free survival (p < 0.001), DDFS (p = 0.01), and OS (p < 0.001) in patients with ypN2–3. Multivariable analysis demonstrated that use of radiotherapy was independently associated with improved LRR [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.45–0.82, p = 0.001] and OS [HR 0.69, 95% CI 0.53–0.89, p = 0.004) for ypN2–3 patients only. The association between radiotherapy and OS was not statistically significant among ypN0 (p = 0.22) and ypN1 patients (p = 0.51). Conclusions: The results from this nationwide database study did not show significant associations between PMRT and improved survival among ypN0 and ypN1 patients. Radiotherapy may be beneficial only for ypN2–3 breast cancer patients who receive NAC and mastectomy in the modern era.

AB - Background: The role of postmastectomy radiotherapy (PMRT) in breast cancer patients receiving neoadjuvant chemotherapy (NAC) is controversial. We aimed to evaluate the effectiveness of radiotherapy in patients treated with NAC and mastectomy in the Japanese Breast Cancer Registry. Methods: We enrolled patients who received NAC and mastectomy for cT1–4 cN0–2 M0 breast cancer. We evaluated the association between radiotherapy and outcomes, locoregional recurrence (LRR), distant disease-free survival (DDFS), and overall survival (OS) based on ypN status by multivariable analysis. Results: Of the 145,530 patients, we identified 3226 who met the inclusion criteria. Among ypN1 patients, no differences were found in LRR, DDFS, or OS between groups with and without radiotherapy (p = 0.72, p = 0.29, and p = 0.36, respectively). Radiotherapy was associated with improved LRR-free survival (p < 0.001), DDFS (p = 0.01), and OS (p < 0.001) in patients with ypN2–3. Multivariable analysis demonstrated that use of radiotherapy was independently associated with improved LRR [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.45–0.82, p = 0.001] and OS [HR 0.69, 95% CI 0.53–0.89, p = 0.004) for ypN2–3 patients only. The association between radiotherapy and OS was not statistically significant among ypN0 (p = 0.22) and ypN1 patients (p = 0.51). Conclusions: The results from this nationwide database study did not show significant associations between PMRT and improved survival among ypN0 and ypN1 patients. Radiotherapy may be beneficial only for ypN2–3 breast cancer patients who receive NAC and mastectomy in the modern era.

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