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Role of Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer Patients: A Study from the Japanese Breast Cancer Registry

  • Minoru MiyashitaEmail author
  • Naoki Niikura
  • Hiraku Kumamaru
  • Hiroaki Miyata
  • Takayuki Iwamoto
  • Masaaki Kawai
  • Keisei Anan
  • Naoki Hayashi
  • Kenjiro Aogi
  • Takanori Ishida
  • Hideji Masuoka
  • Kotaro Iijima
  • Shinobu Masuda
  • Koichiro Tsugawa
  • Takayuki Kinoshita
  • Hitoshi Tsuda
  • Seigo Nakamura
  • Yutaka Tokuda
Breast Oncology

Abstract

Background

The role of postmastectomy radiotherapy (PMRT) in breast cancer patients receiving neoadjuvant chemotherapy (NAC) is controversial. We aimed to evaluate the effectiveness of radiotherapy in patients treated with NAC and mastectomy in the Japanese Breast Cancer Registry.

Methods

We enrolled patients who received NAC and mastectomy for cT1–4 cN0–2 M0 breast cancer. We evaluated the association between radiotherapy and outcomes, locoregional recurrence (LRR), distant disease-free survival (DDFS), and overall survival (OS) based on ypN status by multivariable analysis.

Results

Of the 145,530 patients, we identified 3226 who met the inclusion criteria. Among ypN1 patients, no differences were found in LRR, DDFS, or OS between groups with and without radiotherapy (p = 0.72, p = 0.29, and p = 0.36, respectively). Radiotherapy was associated with improved LRR-free survival (p < 0.001), DDFS (p = 0.01), and OS (p < 0.001) in patients with ypN2–3. Multivariable analysis demonstrated that use of radiotherapy was independently associated with improved LRR [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.45–0.82, p = 0.001] and OS [HR 0.69, 95% CI 0.53–0.89, p = 0.004) for ypN2–3 patients only. The association between radiotherapy and OS was not statistically significant among ypN0 (p = 0.22) and ypN1 patients (p = 0.51).

Conclusions

The results from this nationwide database study did not show significant associations between PMRT and improved survival among ypN0 and ypN1 patients. Radiotherapy may be beneficial only for ypN2–3 breast cancer patients who receive NAC and mastectomy in the modern era.

Notes

Acknowledgment

We thank the JBCS for their grant support to perform the present study. We also thank the affiliated institutes participating in the Japanese Breast Cancer Registry of the JBCS for their efforts to register patients’ data.

Disclosure

Drs. Kumamaru and Miyata are affiliated with the department of Healthcare Quality Assessment at the University of Tokyo, which is a social collaboration department supported by National Clinical Database, Johnson & Johnson KK., and Nipro corporation. The other authors declare no conflicts of interest.

Supplementary material

10434_2019_7453_MOESM1_ESM.docx (229 kb)
Supplementary material 1 (DOCX 228 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Minoru Miyashita
    • 1
    Email author
  • Naoki Niikura
    • 2
  • Hiraku Kumamaru
    • 3
  • Hiroaki Miyata
    • 4
  • Takayuki Iwamoto
    • 5
  • Masaaki Kawai
    • 6
  • Keisei Anan
    • 7
  • Naoki Hayashi
    • 8
  • Kenjiro Aogi
    • 9
  • Takanori Ishida
    • 1
  • Hideji Masuoka
    • 10
  • Kotaro Iijima
    • 11
  • Shinobu Masuda
    • 12
  • Koichiro Tsugawa
    • 13
  • Takayuki Kinoshita
    • 14
  • Hitoshi Tsuda
    • 15
  • Seigo Nakamura
    • 16
  • Yutaka Tokuda
    • 2
  1. 1.Department of Breast and Endocrine Surgical OncologyTohoku University School of MedicineSendaiJapan
  2. 2.Department of Breast and Endocrine SurgeryTokai University School of MedicineIseharaJapan
  3. 3.Department of Healthcare Quality Assessment, Graduate School of MedicineThe University of TokyoTokyoJapan
  4. 4.Department of Health Policy and Management School of MedicineKeio UniversityTokyoJapan
  5. 5.Department of Breast and Endocrine SurgeryOkayama University HospitalOkayamaJapan
  6. 6.Department of Breast SurgeryMiyagi Cancer CenterNatoriJapan
  7. 7.Department of SurgeryKitakyushu Municipal Medical CenterKitakyushuJapan
  8. 8.Department of Breast Surgical OncologySt. Luke’s International HospitalTokyoJapan
  9. 9.Department of Breast SurgeryShikoku Cancer CenterMatsuyamaJapan
  10. 10.Sapporo-Kotoni Breast ClinicSapporoJapan
  11. 11.Department of Breast SurgeryJuntendo University School of MedicineTokyoJapan
  12. 12.Department of PathologyNihon University School of MedicineTokyoJapan
  13. 13.Division of Breast and Endocrine Surgery, Department of SurgerySt. Marianna University School of MedicineKawasakiJapan
  14. 14.Department of Breast SurgeryNational Cancer Center HospitalTokyoJapan
  15. 15.Department of Basic PathologyNational Defense Medical CollegeSaitamaJapan
  16. 16.Division of Breast Surgical Oncology, Department of SurgeryShowa University School of MedicineTokyoJapan

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