[an error occurred while processing this directive] | [an error occurred while processing this directive]
Efficacy and prognostic analysis of chest wall boost radiotherapy in stage T4 breast cancer patients after modified radical mastectomy
Song Yuchun, Deng Yanbo, Wang Shulian, Song Yongwen, Tang Yu, Yang Yong, Fang Hui, Wang Jianyang, Jing Hao, Zhang Jianghu, Sun Guangyi, Chen Siye, Zhao Xuran, Jin Jing, Liu Yueping, Chen Bo, Qi Shunan, Li Ning, Tang Yuan, Lu Ningning, Li Yexiong
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
AbstractObjective To analyze the efficacy of chest wall boost radiotherapy in stage T4 breast cancer patients after modified radical mastectomy. Methods A retrospective analysis was performed on the data of 148 stage T4 breast cancer patients who were admitted from 2000 to 2016 and received radiotherapy after modified radical mastectomy. There were 57 cases in the chest wall boost radiotherapy group and 91 cases in the conventional dose group. Radiotherapy was performed by conventional+ chest wall electron beam, three-dimensional conformal+ chest wall electron beam, intensity modulated radiotherapy+ chest wall electron beam irradiation. EQD2 at the boost group was >50Gy. All patients received neoadjuvant chemotherapy. Kaplan-Meier method was used to analyze survival;Logrank was used to test differences;and Cox model was used to do multivariate prognostic analysis. Results The median follow-up time was 67.2 months. The 5-year rates of chest wall recurrence (CWR), locoregional recurrence (LRR), disease-free survival (DFS), and overall survival (OS) were 9.9%, 16.2%, 58.0%, and 71.4%, respectively. The 5-year rates of CWR, LRR, DFS, and OS with and without chest wall boost radiotherapy were 14% vs. 7%, 18% vs. 15%, 57% vs. 58%, 82% vs. 65%(P>0.05), respectively. Multivariate analysis showed that chest wall boost radiotherapy had no significant effect on prognosis (P>0.05). Among 45 patients in the recurrent high-risk group, boost radiotherapy seemed to have higher OS rate (P=0.058), DFS rate (P=0.084), and lower LRR rate (P=0.059). Conclusions Stage T4 breast cancer patients had strong heterogeneity. Chest wall boost radiotherapy did not apparently benefit all patients. For patients with 2-3 high risk factors including positive vascular tumor embolus, pN2-N3, and hormone receptor negative, chest wall boost radiotherapy showed a trend of improving efficacy.
Fund:Beijing Capital Characteristic Clinical Project (Z171100001017116);Beijing Hope Marathon Special Fund, Cancer Foundation of China (LC2016A09)
Corresponding Authors:
Wang Shulian, Email:wsl20040118@yahoo.com
Cite this article:
Song Yuchun,Deng Yanbo,Wang Shulian et al. Efficacy and prognostic analysis of chest wall boost radiotherapy in stage T4 breast cancer patients after modified radical mastectomy[J]. Chinese Journal of Radiation Oncology, 2020, 29(5): 342-348.
Song Yuchun,Deng Yanbo,Wang Shulian et al. Efficacy and prognostic analysis of chest wall boost radiotherapy in stage T4 breast cancer patients after modified radical mastectomy[J]. Chinese Journal of Radiation Oncology, 2020, 29(5): 342-348.
[1] Woodward WA, Strom EA, Tucker SL, et al. Changes in the 2003 American Joint Committee on Cancer staging for breast cancer dramatically affect stage-specific survival[J]. J Clin Oncol, 2003, 21(17):3244-3248. DOI:10.1200/jco.2003.03.052.
[2] Hortobagyi GN. Comprehensive management of locally advanced breast cancer[J]. Cancer, 1990, 66(6 Suppl):1387-1391. DOI:10.1002/1097-0142(19900915)66:14+<1387::AID-CNCR2820661414>3.0. CO;2-I.
[3] Lee MC, Newman LA. Management of patients with locally advanced breast cancer[J]. Surg Clin North Am, 2007, 87(2):379-398, ix. DOI:10.1016/j.suc.2007.01.012.
[4] 王淑莲, 余子豪, 李晔雄, 等. 乳腺癌改良根治术后复发高危患者的放疗结果和预后因素分析[J]. 中华放射肿瘤学杂志, 2009, 18(6):466-469. DOI:10.3760/cma.j.issn.1004-4221.2009.06.466.
[5] Bartelink H, Horiot JC, Poortmans PM, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer:10-year results of the randomized boost versus no boost EORTC 22881-10882 trial[J]. J Clin Oncol, 2007, 25(22):3259-3265. DOI:10.1200/jco.2007.11.4991.
[6] Vrieling C, Van WE, Maingon P, et al. Prognostic factors for local control in breast cancer after lLong-term follow-up in the EORTC boost vs. no boost trial:a randomized clinical trial[J]. JAMA Oncol, 2017, 3(1):42-48. DOI:10.1001/jamaoncol.2016.3031.
[7] Liao Z, Strom EA, Buzdar AU, et al. Locoregional irradiation for inflammatory breast cancer:effectiveness of dose escalation in decreasing recurrence[J]. Int J Radiat Oncol Biol Phys, 2000, 47(5):1191-200. DOI:10.1016/s0360-3016(00)00561-7.
[8] Bristol IJ, Woodward WA, Strom EA, et al. Locoregional treatment outcomes after multimodality management of inflammatory breast cancer[J]. Int J Radiat Oncol Biol Phys, 2008, 72(2):474-484. DOI:10.1016/j.ijrobp.2008.01.039.
[9] Panoff JE, Takita C, Hurley J, et al. Higher chest wall dose results in improved locoregional outcome in patients receiving postmastectomy radiation[J]. Int J Radiat Oncol Biol Phys, 2012, 82(3):1192-1199. DOI:10.1016/j.ijrobp.2011.02.045.
[10] Dawood S, Lei X, Dent R, et al. Survival of women with inflammatory breast cancer:a large population-based study[J]. Ann Oncol, 2014, 25(6):1143-1151. DOI:10.1093/annonc/mdu121.
[11] Dawood S, Ueno NT, Valero V, et al. Identifying factors that
impact survival among women with inflammatory breast cancer[J].Ann Oncol, 2012, 23(4):870-875. DOI:10.1093/annonc/mdr319.
[12] Low JA, Berman AW, Steinberg SM, et al. Long-term follow-up for locally advanced and inflammatory breast cancer patients treated with multimodality therapy[J]. J Clin Oncol, 2004, 16(2):185-185. DOI:10.1016/S1043-321X (05)80147-X.
[13] Hance KW, Anderson WF, Devesa SS, et al. Trends in inflammatory breast carcinoma incidence and survival:the surveillance, epidemiology, and end results program at the National Cancer Institute[J]. J Natl Cancer Inst, 2005, 97(13):966-975. DOI:10.1093/jnci/dji172.
[14] 王淑莲, 余子豪, 杨红鹰, 等. 皮肤受侵非炎性和炎性乳腺癌的放疗结果[J]. 中华放射肿瘤学杂志, 2010, 19(5):437-440. DOI:10.3760/cma.j.issn.1004-4221.2010.05.016.
[15] Montagna E, Bagnardi V, Rotmensz N, et al. Factors that predict early treatment failure for patients with locally advanced (T4) breast cancer[J]. Br J Cancer, 2008, 98(11):1745-1752. DOI:10.1038/sj.bjc.6604384.
[16] Huang EH, Tucker SL, Strom EA, et al. Predictors of locoregional recurrence in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy, mastectomy, and radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2005, 62(2):351-357. DOI:10.1016/j.ijrobp.2004.09.056.
[17] Fouad T. Differences in survival among women with stage Ⅲ inflammatory and noninflammatory locally advanced breast cancer appear early:a large population-based study[J]. Cancer, 2012, 118(4):1171-1173. DOI:10.1002/cncr.26397.
[18] Cristofanilli M, Valero V, Buzdar AU, et al. Inflammatory breast cancer (IBC) and patterns of recurrence:understanding the biology of a unique disease[J]. Cancer, 2007, 110(7):1436-1444. DOI:10.1002/cncr.22927.
[19] Whelan TJ, Olivotto IA, Parulekar WR, et al. Regional nodal iIrradiation in early-stage breast cancer[J]. N Engl J Med, 2015, 373(4):307-316. DOI:10.1056/NEJMoa1415340.
[20] Poortmans PM, Collette S, Kirkove C, et al. Internal mammary and medial supraclavicular irradiation in breast cancer[J]. N Engl J Med, 2015, 373(4):317-327. DOI:10.1056/NEJMoa1415369.
[21] Torres-Roca JF, Fulp WJ, Caudell JJ, et al. Integration of a radiosensitivity molecular signature into the assessment of local recurrence risk in breast cancer[J]. Int J Radiat Oncol Biol Phys, 2015, 93(3):631-638. DOI:10.1016/j.ijrobp.2015.06.021.
[22] Andrade D, Mehta M, Griffith J, et al. YAP1 inhibition radiosensitizes triple negative breast cancer cells by targeting the DNA damage response and cell survival pathways[J]. Oncotarget, 2017, 8(58):98495-98508. DOI:10.18632/oncotarget.21913.
2020, Vol. 29 
