Predictors of locoregional outcome in patients receiving neoadjuvant therapy and postmastectomy radiation

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Abstract

Background: The objective of this study was to identify predictors of locoregional recurrence (LRR) after neoadjuvant therapy (NAT) and postmastectomy radiation (PMRT) in a cohort of patients with stage II through III breast cancer and to determine whether omission of the supraclavicular field had an impact on the risk of LRR. Methods: The authors reviewed records from 464 patients who received NAT and PMRT from January 1999 to December 2009. Results: The median patient age was 50 years (range, 25-81 years). Clinical disease stage was stage II in 29% of patients, stage III in 71%, and inflammatory in 14%. Receptor status was estrogen receptor (ER)-positive in 54% of patients, progesterone receptor (PR)-positive in 39%, human epidermal growth factor receptor 2 (HER2)-positive in 24%, and negative for all 3 receptors (triple negative) in 32%. All patients received NAT and underwent mastectomy, and 19.6% had a complete pathologic response in the breast and axilla, 17.5% received radiation to the chest wall only, and 82.5% received radiation to the chest wall and the supraclavicular field; omission of the supraclavicular field was more common in patients with lower clinical and pathologic lymph node status. The median follow-up was 50.5 months, and the 5-year cumulative incidence of LRR was 6% (95% confidence interval, 3.9%-8.6%). Predictors of LRR were clinical stage III (P =.038), higher clinical lymph node status (P =.025), higher pathologic lymph node status (P =.003), the combination of clinically and pathologically positive lymph nodes (P <.001), inflammatory presentation (P =.037), negative ER status (P =.006), negative PR status (P =.015), triple-negative status (P <.001), and pathologic tumor size >2 cm (P =.045). On univariate analysis, omission of the supraclavicular field was not associated significantly with LRR (hazard ratio, 0.89; P =.833); however, on multivariate analyses, omission of the supraclavicular field was associated significantly with LRR (hazard ratio, 3.39; P =.024). Conclusions: Presenting stage, receptor status, pathologic response to neoadjuvant therapy, and omission the supraclavicular field were identified as risk factors for LRR after neoadjuvant therapy and PMRT.

Original languageEnglish
Pages (from-to)16-25
Number of pages10
JournalCancer
Volume119
Issue number1
DOIs
StatePublished - Jan 1 2013

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Neoadjuvant Therapy
Radiation
Recurrence
Lymph Nodes
Thoracic Wall
Axilla
Mastectomy
Progesterone Receptors
Estrogen Receptors
Breast
Multivariate Analysis
Confidence Intervals
Breast Neoplasms
Incidence

Keywords

  • breast cancer
  • locoregional
  • neoadjuvant therapy
  • postmastectomy radiation
  • supraclavicular radiation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Predictors of locoregional outcome in patients receiving neoadjuvant therapy and postmastectomy radiation. / Wright, Jean L.; Takita, Cristiane; Reis, Isildinha; Zhao, Wei; Saigal, Kunal; Wolfson, Aaron; Markoe, Arnold; Moller, Mecker; Hurley, Judith.

In: Cancer, Vol. 119, No. 1, 01.01.2013, p. 16-25.

Research output: Contribution to journalArticle

@article{1181c0e2d00f4ebba9b8290f736d3f40,
title = "Predictors of locoregional outcome in patients receiving neoadjuvant therapy and postmastectomy radiation",
abstract = "Background: The objective of this study was to identify predictors of locoregional recurrence (LRR) after neoadjuvant therapy (NAT) and postmastectomy radiation (PMRT) in a cohort of patients with stage II through III breast cancer and to determine whether omission of the supraclavicular field had an impact on the risk of LRR. Methods: The authors reviewed records from 464 patients who received NAT and PMRT from January 1999 to December 2009. Results: The median patient age was 50 years (range, 25-81 years). Clinical disease stage was stage II in 29{\%} of patients, stage III in 71{\%}, and inflammatory in 14{\%}. Receptor status was estrogen receptor (ER)-positive in 54{\%} of patients, progesterone receptor (PR)-positive in 39{\%}, human epidermal growth factor receptor 2 (HER2)-positive in 24{\%}, and negative for all 3 receptors (triple negative) in 32{\%}. All patients received NAT and underwent mastectomy, and 19.6{\%} had a complete pathologic response in the breast and axilla, 17.5{\%} received radiation to the chest wall only, and 82.5{\%} received radiation to the chest wall and the supraclavicular field; omission of the supraclavicular field was more common in patients with lower clinical and pathologic lymph node status. The median follow-up was 50.5 months, and the 5-year cumulative incidence of LRR was 6{\%} (95{\%} confidence interval, 3.9{\%}-8.6{\%}). Predictors of LRR were clinical stage III (P =.038), higher clinical lymph node status (P =.025), higher pathologic lymph node status (P =.003), the combination of clinically and pathologically positive lymph nodes (P <.001), inflammatory presentation (P =.037), negative ER status (P =.006), negative PR status (P =.015), triple-negative status (P <.001), and pathologic tumor size >2 cm (P =.045). On univariate analysis, omission of the supraclavicular field was not associated significantly with LRR (hazard ratio, 0.89; P =.833); however, on multivariate analyses, omission of the supraclavicular field was associated significantly with LRR (hazard ratio, 3.39; P =.024). Conclusions: Presenting stage, receptor status, pathologic response to neoadjuvant therapy, and omission the supraclavicular field were identified as risk factors for LRR after neoadjuvant therapy and PMRT.",
keywords = "breast cancer, locoregional, neoadjuvant therapy, postmastectomy radiation, supraclavicular radiation",
author = "Wright, {Jean L.} and Cristiane Takita and Isildinha Reis and Wei Zhao and Kunal Saigal and Aaron Wolfson and Arnold Markoe and Mecker Moller and Judith Hurley",
year = "2013",
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T1 - Predictors of locoregional outcome in patients receiving neoadjuvant therapy and postmastectomy radiation

AU - Wright, Jean L.

AU - Takita, Cristiane

AU - Reis, Isildinha

AU - Zhao, Wei

AU - Saigal, Kunal

AU - Wolfson, Aaron

AU - Markoe, Arnold

AU - Moller, Mecker

AU - Hurley, Judith

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background: The objective of this study was to identify predictors of locoregional recurrence (LRR) after neoadjuvant therapy (NAT) and postmastectomy radiation (PMRT) in a cohort of patients with stage II through III breast cancer and to determine whether omission of the supraclavicular field had an impact on the risk of LRR. Methods: The authors reviewed records from 464 patients who received NAT and PMRT from January 1999 to December 2009. Results: The median patient age was 50 years (range, 25-81 years). Clinical disease stage was stage II in 29% of patients, stage III in 71%, and inflammatory in 14%. Receptor status was estrogen receptor (ER)-positive in 54% of patients, progesterone receptor (PR)-positive in 39%, human epidermal growth factor receptor 2 (HER2)-positive in 24%, and negative for all 3 receptors (triple negative) in 32%. All patients received NAT and underwent mastectomy, and 19.6% had a complete pathologic response in the breast and axilla, 17.5% received radiation to the chest wall only, and 82.5% received radiation to the chest wall and the supraclavicular field; omission of the supraclavicular field was more common in patients with lower clinical and pathologic lymph node status. The median follow-up was 50.5 months, and the 5-year cumulative incidence of LRR was 6% (95% confidence interval, 3.9%-8.6%). Predictors of LRR were clinical stage III (P =.038), higher clinical lymph node status (P =.025), higher pathologic lymph node status (P =.003), the combination of clinically and pathologically positive lymph nodes (P <.001), inflammatory presentation (P =.037), negative ER status (P =.006), negative PR status (P =.015), triple-negative status (P <.001), and pathologic tumor size >2 cm (P =.045). On univariate analysis, omission of the supraclavicular field was not associated significantly with LRR (hazard ratio, 0.89; P =.833); however, on multivariate analyses, omission of the supraclavicular field was associated significantly with LRR (hazard ratio, 3.39; P =.024). Conclusions: Presenting stage, receptor status, pathologic response to neoadjuvant therapy, and omission the supraclavicular field were identified as risk factors for LRR after neoadjuvant therapy and PMRT.

AB - Background: The objective of this study was to identify predictors of locoregional recurrence (LRR) after neoadjuvant therapy (NAT) and postmastectomy radiation (PMRT) in a cohort of patients with stage II through III breast cancer and to determine whether omission of the supraclavicular field had an impact on the risk of LRR. Methods: The authors reviewed records from 464 patients who received NAT and PMRT from January 1999 to December 2009. Results: The median patient age was 50 years (range, 25-81 years). Clinical disease stage was stage II in 29% of patients, stage III in 71%, and inflammatory in 14%. Receptor status was estrogen receptor (ER)-positive in 54% of patients, progesterone receptor (PR)-positive in 39%, human epidermal growth factor receptor 2 (HER2)-positive in 24%, and negative for all 3 receptors (triple negative) in 32%. All patients received NAT and underwent mastectomy, and 19.6% had a complete pathologic response in the breast and axilla, 17.5% received radiation to the chest wall only, and 82.5% received radiation to the chest wall and the supraclavicular field; omission of the supraclavicular field was more common in patients with lower clinical and pathologic lymph node status. The median follow-up was 50.5 months, and the 5-year cumulative incidence of LRR was 6% (95% confidence interval, 3.9%-8.6%). Predictors of LRR were clinical stage III (P =.038), higher clinical lymph node status (P =.025), higher pathologic lymph node status (P =.003), the combination of clinically and pathologically positive lymph nodes (P <.001), inflammatory presentation (P =.037), negative ER status (P =.006), negative PR status (P =.015), triple-negative status (P <.001), and pathologic tumor size >2 cm (P =.045). On univariate analysis, omission of the supraclavicular field was not associated significantly with LRR (hazard ratio, 0.89; P =.833); however, on multivariate analyses, omission of the supraclavicular field was associated significantly with LRR (hazard ratio, 3.39; P =.024). Conclusions: Presenting stage, receptor status, pathologic response to neoadjuvant therapy, and omission the supraclavicular field were identified as risk factors for LRR after neoadjuvant therapy and PMRT.

KW - breast cancer

KW - locoregional

KW - neoadjuvant therapy

KW - postmastectomy radiation

KW - supraclavicular radiation

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