The importance of postoperative radiation therapy in multimodality management of locally advanced breast cancer

A phase II trial of neoadjuvant MVAC, surgery, and radiation

May Abdel-Wahab, Aaron Wolfson, William Raub, Carolyn Mies, Alfred Brandon, Louise Morrell, Young Lee, Stella Ling, Arnold Markoe

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Purpose: To determine the impact of postoperative radiation on locoregional relapse and overall survival rate in a multimodality protocol for locally advanced breast cancer (LABC). Material and Methods: Of the patients entered in the protocol, 55 were evaluable. Treatment consisted of: neoadjuvant MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) until a maximum response had been achieved; modified radical mastectomy; 6 courses of postoperative adjuvant MVAC chemotherapy, and chest wall irradiation (CWXRT). Multivariate analysis of locoregional response and overall survival was done. Results: Of the total, 42 patients received chest wall radiation; 28 of these also received radiation to regional lymph nodes. Chest wall doses ranged from 45 Gy to 50.4 Gy to the whole chest wall, with 31 patients receiving an additional chest-wall boost. The incidence of locoregional relapse with and without radiation was 7% vs. 31%, respectively (p = 0.026). An overall survival benefit was seen in those receiving radiation, with a mean overall survival of 50 months vs. 20 months, and a 3-year overall survival of 88% vs. 46% with and without radiation respectively (p = 0.003). Multivariate analysis showed that overall survival was affected by the presence of pathological CR (p = .047), the number of pre-operative chemotherapy cycles (p = .036) and whether or not they received radiation (p = 0.003). Neither the interval between surgery and radiation, technique of radiation, nor radiation modality significantly affected local control. Conclusion: The significant improvement in local regional control and overall survival with the addition of radiation suggests that radiation should be an integral part of multimodality management of locally advanced breast cancer.

Original languageEnglish
Pages (from-to)875-880
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume40
Issue number4
DOIs
StatePublished - Mar 1 1998

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Vinblastine
surgery
Methotrexate
breast
Doxorubicin
Cisplatin
radiation therapy
Radiotherapy
cancer
Radiation
Breast Neoplasms
radiation
chest
Thoracic Wall
Survival
chemotherapy
Multivariate Analysis
Modified Radical Mastectomy
Recurrence
Drug Therapy

Keywords

  • Locally advanced breast cancer
  • Multimodality treatment
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

The importance of postoperative radiation therapy in multimodality management of locally advanced breast cancer : A phase II trial of neoadjuvant MVAC, surgery, and radiation. / Abdel-Wahab, May; Wolfson, Aaron; Raub, William; Mies, Carolyn; Brandon, Alfred; Morrell, Louise; Lee, Young; Ling, Stella; Markoe, Arnold.

In: International Journal of Radiation Oncology Biology Physics, Vol. 40, No. 4, 01.03.1998, p. 875-880.

Research output: Contribution to journalArticle

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abstract = "Purpose: To determine the impact of postoperative radiation on locoregional relapse and overall survival rate in a multimodality protocol for locally advanced breast cancer (LABC). Material and Methods: Of the patients entered in the protocol, 55 were evaluable. Treatment consisted of: neoadjuvant MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) until a maximum response had been achieved; modified radical mastectomy; 6 courses of postoperative adjuvant MVAC chemotherapy, and chest wall irradiation (CWXRT). Multivariate analysis of locoregional response and overall survival was done. Results: Of the total, 42 patients received chest wall radiation; 28 of these also received radiation to regional lymph nodes. Chest wall doses ranged from 45 Gy to 50.4 Gy to the whole chest wall, with 31 patients receiving an additional chest-wall boost. The incidence of locoregional relapse with and without radiation was 7{\%} vs. 31{\%}, respectively (p = 0.026). An overall survival benefit was seen in those receiving radiation, with a mean overall survival of 50 months vs. 20 months, and a 3-year overall survival of 88{\%} vs. 46{\%} with and without radiation respectively (p = 0.003). Multivariate analysis showed that overall survival was affected by the presence of pathological CR (p = .047), the number of pre-operative chemotherapy cycles (p = .036) and whether or not they received radiation (p = 0.003). Neither the interval between surgery and radiation, technique of radiation, nor radiation modality significantly affected local control. Conclusion: The significant improvement in local regional control and overall survival with the addition of radiation suggests that radiation should be an integral part of multimodality management of locally advanced breast cancer.",
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