Locoregional Recurrence Risk in Breast Cancer Patients with Estrogen Receptor Positive Tumors and Residual Nodal Disease following Neoadjuvant Chemotherapy and Mastectomy without Radiation Therapy.

• Type of Material: Article
• Authors: Shravan Kandula, Emory University; Jeffrey Switchenko, Emory University; Saul Harari, Emory University; Carolina Fasola, Stanford Medical Center; Donna Mister, Emory University; David Yu, Emory University; Amelia Zelnak, Emory University; Mylin Torres, Emory University
• Language: English
• Date: 2015
• Publisher: Hindawi Publishing Corporation
• Publication Version: Final Published Version
• Copyright Statement: © 2015 Shravan Kandula et al.
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1155/2015/147476
• Title of Journal or Parent Work: International Journal of Breast Cancer
• ISSN: 2090-3170
• Volume: 2015
• Start Page: 147476
• End Page: 147476
• Grant/Funding Information: Biostatistics and Bioinformatics Shared Resource of the Winship Cancer Institute of Emory University; National Institutes of Health (NIH)/National Cancer Institute (NCI) under Award no. P30CA138292
• Research Categories: Biology, Biostatistics; Health Sciences, Oncology; Health Sciences, Pathology

Abstract

Among breast cancer patients treated with neoadjuvant chemotherapy (NAC) and mastectomy, locoregional recurrence (LRR) rates are unclear in women with ER+ tumors treated with adjuvant endocrine therapy without postmastectomy radiation (PMRT). To determine if PMRT is needed in these patients, we compared LRR rates of patients with ER+ tumors (treated with adjuvant endocrine therapy) with women who have non-ER+ tumors. 85 consecutive breast cancer patients (87 breast tumors) treated with NAC and mastectomy without PMRT were reviewed. Patients were divided by residual nodal disease (ypN) status (ypN+ versus ypN0) and then stratified by receptor subtype. Among ypN+ patients (n = 35), five-year LRR risk in patients with ER+, Her2+, and triple negative tumors was 5%, 33%, and 37%, respectively (p = 0.02). Among ypN+/ER+ patients, lymphovascular invasion and grade three disease increased the five-year LRR risk to 13% and 11%, respectively. Among ypN0 patients (n = 52), five-year LRR risk in patients with ER+, Her2+, and triple negative tumors was 7%, 22%, and 6%, respectively (p = 0.71). In women with ER+ tumors and residual nodal disease, endocrine therapy may be sufficient adjuvant treatment, except in patients with lymphovascular invasion or grade three tumors where PMRT may still be indicated.