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Sousa C, Cruz M, Neto A, Pereira K, Peixoto M, Bastos J, Henriques M, Roda D, Marques R, Miranda C, Melo G, Sousa G, Figueiredo P, Alves P. Neoadjuvant radiotherapy in the approach of locally advanced breast cancer. ESMO Open 2020; 4:S2059-7029(20)30060-0. [PMID: 32152044 PMCID: PMC7082639 DOI: 10.1136/esmoopen-2019-000640] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 12/31/2022] Open
Abstract
Background Approximately 4% of European patients are diagnosed with locally advanced breast cancer (LABC), a clinical condition commonly associated with poorer prognosis. Systemic therapy is the recommended initial treatment and when inoperability criteria prevails, radiotherapy (RT) should be used for tumour downstaging. This study intends to evaluate the impact of neoadjuvant radiotherapy (NART) in the treatment of inoperable LABC. Methods A retrospective study of female patients, submitted to the NART between January 2014 and December 2018 at our institution. The evaluation of pathological response (pR) was made based on Pinder criteria. Primary endpoint: pR. Secondary endpoints: overall survival (OS) and progression-free survival (PFS). OS and PFS were calculated using the Kaplan-Meier method. Differences between groups were compared using Student’s t-test, ANOVA (Analysis of variance) and χ2 test. The statistical analyses were performed using Stata (V.13). Results A total of 76 patients were included, 18% with breast complete response. The 5 years OS was 54% and PFS was 61%. Subgroup analysis showed that pR >90% is correlated with a better OS (p=0.004). Basal-like intrinsic subtype is correlated with worse OS and PFS (p<0.05). No relation was found between response and age, intrinsic subtype, treatment performed and clinical T stage. Conclusion Our study confirms that NART is an effective downsizing treatment in inoperable LABC, allowing for a surgical resection regardless of the systemic treatment performed. Response to NART is independent of the intrinsic subtype and pR >90% is correlated with a better OS. Prospective studies to explore predictive response biomarkers are necessary in order to improve patient selection and optimisation of the treatment.
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Affiliation(s)
- Cláudia Sousa
- Radiotherapy, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
| | - Mafalda Cruz
- Radiotherapy, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
| | - Ana Neto
- Radiotherapy, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
| | - Kayla Pereira
- Radiotherapy, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
| | - Marta Peixoto
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
| | - Joana Bastos
- Regional Oncology Registry of the Centre, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
| | - Mónica Henriques
- Radiotherapy, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
| | - Domingos Roda
- Radiotherapy, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
| | - Rui Marques
- Radiotherapy, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
| | - Cristina Miranda
- Radiotherapy, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
| | - Gilberto Melo
- Radiotherapy, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
| | - Gabriela Sousa
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
| | - Paulo Figueiredo
- Anatomical Pathology, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
| | - Paula Alves
- Radiotherapy, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E, Coimbra, Portugal
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Fu W, Sun H, Zhao Y, Chen M, Yang L, Gao S, Li L, Jin W. Trends and outcomes of neoadjuvant radiotherapy compared with postoperative radiotherapy for malignant breast cancer. Oncotarget 2018; 9:24525-24536. [PMID: 29849958 PMCID: PMC5966264 DOI: 10.18632/oncotarget.24313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 12/04/2017] [Indexed: 01/05/2023] Open
Abstract
Background Although neoadjuvant treatment has become the established approach for women with large primary tumors or locally advanced breast cancer for which immediate surgery is not the best approach, it may also stimulate cancer stem cell self-renewal and facilitate recurrence. We sought to determine the survival outcomes of preoperative radiotherapy (PRRT) compared with postoperative radiotherapy (PORT). Materials and Methods The Surveillance, Epidemiology, and End Results (SEER) registry was queried for patients who were diagnosed with breast cancer and underwent cancer-directed surgery. Survival analyses were performed with Cox proportional hazard regression for both overall survival (OS) and disease-specific survival (DSS), and 1:1 propensity score (PS) matching-adjusted competing risk analyses were conducted for DSS. Results We first identified 1,111,218 eligible patients in 18 registries from 1973 to 2013 and found that, outside of the Utah registry, sequence patterns other than PORT were rarely used. Thus, we next identified eligible patients registered in Utah (n = 7,042) from 1988 to 2007. The treatment trends shifted abruptly in 1988. Compared with the PORT group, the PRRT group showed significantly higher risks of overall mortality (absolute difference, 22.4%; P < 0.001), breast cancer-specific mortality (absolute difference, 8.6%; P < 0.001), and cardiovascular disease-specific mortality (absolute difference, 11.5%; P = 0.021). Survival differences in treatment sequences were correlated with stage. Conclusions Substantial shifts in treatment patterns for malignant breast cancer were identified in Utah. Compared with PORT, PRRT showed significantly worse outcomes. These results could inform future standardized options for radiation sequence with surgery and further clinical trials.
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Affiliation(s)
- Wenyan Fu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Collaborative Innovation Center of Cancer Medicine, Fudan University Shanghai Cancer Center, Shanghai 200030, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200030, China
| | - Hefen Sun
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Collaborative Innovation Center of Cancer Medicine, Fudan University Shanghai Cancer Center, Shanghai 200030, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200030, China
| | - Yang Zhao
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Collaborative Innovation Center of Cancer Medicine, Fudan University Shanghai Cancer Center, Shanghai 200030, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200030, China
| | - Mengting Chen
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Collaborative Innovation Center of Cancer Medicine, Fudan University Shanghai Cancer Center, Shanghai 200030, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200030, China
| | - Lipeng Yang
- Department of Pathology, School of Basic Medical Sciences, Fudan University, Shanghai 200030, China
| | - Shuiping Gao
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Collaborative Innovation Center of Cancer Medicine, Fudan University Shanghai Cancer Center, Shanghai 200030, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200030, China
| | - Liangdong Li
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Collaborative Innovation Center of Cancer Medicine, Fudan University Shanghai Cancer Center, Shanghai 200030, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200030, China
| | - Wei Jin
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Collaborative Innovation Center of Cancer Medicine, Fudan University Shanghai Cancer Center, Shanghai 200030, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200030, China
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Vieira RADC, da Silva KMT, de Oliveira-Junior I, de Lima MA. ITADE flap after mastectomy for locally advanced breast cancer: A good choice for mid-sized defects of the chest wall, based on a systematic review of thoracoabdominal flaps. J Surg Oncol 2017; 115:949-958. [DOI: 10.1002/jso.24619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/02/2017] [Indexed: 12/15/2022]
Affiliation(s)
- René Aloisio da Costa Vieira
- Postgraduate Program in Oncology, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - Katia Mathias Teixeira da Silva
- Postgraduate Program in Oncology, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - Idam de Oliveira-Junior
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - Marcos Alves de Lima
- Center of Epidemiology and Statistics, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
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