局部晚期乳腺癌新辅助化疗和改良根治术后放疗价值分析

doi:10.3760/cma.j.issn.1004-4221.2017.08.008

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Abstract Objective To evaluate the value of postmastectomy radiotherapy (PMRT) in locally advanced breast cancer patients treated with neoadjuvant chemotherapy (neoCT) and modified radical mastectomy, and to investigate the possibility of individualized radiotherapy according to the response to neoCT. Methods We analyzed 523 patients with stage Ⅲ_A and Ⅲ_B breast cancer who received neoCT and modified radical mastectomy in our hospital from 1999 to 2013. Of all patients, 404 received PMRT, and 119 did not. The locoregional recurrence (LRR), disease-free survival (DFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method, survival difference analysis and univariate prognostic analysis were performed using the log-rank test, and multivariate prognostic analysis was performed using the Cox regression model. Results Compared with those not treated with PMRT, the patients treated with PMRT had a significantly lower 5-year LRR rate (13.9% vs. 24.8%, P=0.013), a significantly higher DFS rate (64.1% vs. 53.9%, P=0.048), and an insignificantly higher OS rate (83.2% vs. 78.2%, P=0.389). In the patients with ypT₃-T₄, ypN₂-N₃, or pathologic stage Ⅲ disease, those treated with PMRT had a significantly reduced 5-year LRR rate (P<0.05) and a significantly increased 5-year OS rate (P<0.05), as compared with those not treated with PMRT. Among the 158 patients with ypN₀ disease, the 5-year LRR rate was significantly lower in those treated with PMRT than in those not treated with PMRT (P=0.004). Of 41 patients who achieved a pathologic complete response, 2 patients, who did not receive PMRT, developed LRR. The multivariate prognostic analysis indicated that PMRT was an independent prognostic factor associated with reduced LRR in all patients and ypN₀ patients. Conclusions In patients with stage Ⅲ_A and Ⅲ_B breast cancer treated with neoCT and modified radical mastectomy, PMRT can significantly reduce LRR for all patients and can reduce both recurrence and mortality for those with ypT₃-T₄, ypN₂-N₃, or pathologic stage Ⅲ disease. There is no sufficient evidence that PMRT can be omitted safely for ypN₀ or pCR patients according to their response to neoCT.

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	Articles by authors
	Rong Qinglin
	Wang Shulian
	Tang Yu
	Jin Jing
	Song Yongwen
	Wang Weihu
	Liu Yueping
	Fang Hui
	Ren Hua
	Liu Xinfan
	Yu Zihao
	Li Yexiong

Key words： Breast neoplasms/chemotherapy chemotherapy,neoadjuvant Breast neoplasms/surgery Surgery,mastectomy Breast neoplasms/radiotherapy Prognosis

Received: 03 March 2017

Fund:National Key Projects of Research and Development (2016YFC0904600);CAMS Medical and Health Science and Technology Innovation Program (2016-I2M-1-001)

Corresponding Authors: Wang Shulian,Email:wangshulian@sohu.com;Li Yexiong,Email:yexiong12@163.com

Cite this article:

Rong Qinglin,Wang Shulian,Tang Yu et al. Value of postmastectomy radiotherapy in locally advanced breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy[J]. Chinese Journal of Radiation Oncology, 2017, 26(8): 884-891.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2017.08.008 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2017/V26/I8/884

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