Skip to main content
SpringerLink
Log in

Adjuvant Radiation Therapy After Preoperative Chemotherapy

  • Chapter
  • First Online:
Breast Disease

  • 855 Accesses

Abstract

The decision to treat patients with radiotherapy after preoperative chemotherapy is still largely based on the initial clinical staging of the patients. The use of three-field radiotherapy (RT) including the chest wall/breast and regional lymphatics after surgery in locally advanced, node-positive patients receiving neoadjuvant systemic chemotherapy is well established. Patients with clinically staged T3–T4 tumors, pathological non-complete responders in the axilla, and younger patients (<35) with cT2N1 or worse disease should be treated with RT according to retrospective data. A pooled analysis of the National Surgical Adjuvant Breast and Bowel Project (NSABP) B18 and B27 trials is the only prospective dataset that can assist radiotherapy decisions in the neoadjuvant setting. Although the results of this analysis should be validated with modern studies (i.e., proper anti-HER-2 and hormonal treatment), selected patients (cT1–2, cN1, and >40 years old) with pathological complete response (pCR) (ypT0, ypTis, ypN0) and non-triple-negative histology after neoadjuvant chemotherapy could possibly be followed without postmastectomy radiotherapy (PMRT) and without regional irradiation in a breast-conserving setting. Well-designed randomized, controlled studies are urgently needed in this controversial area.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hoffman KE, Mittendorf EA, Buchholz TA. Optimising radiation treatment decisions for patients who receive neoadjuvant chemotherapy and mastectomy. Lancet Oncol. 2012;13(6):e270–6.

    Article  Google Scholar 

  2. Mieog JS, van der Hage JA, van de Velde CJ. Preoperative chemotherapy for women with operable breast cancer. Cochrane Database Syst Rev. 2007;2:CD005002.

    Google Scholar 

  3. Boughey JC, Suman VJ, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455–61.

    Article  CAS  Google Scholar 

  4. Eifel P, Axelson JA, Costa J, Crowley J, Curran WJ Jr, Deshler A, et al. National Institutes of Health Consensus Development Conference Statement: adjuvant therapy for breast cancer, November 1–3, 2000. J Natl Cancer Inst. 2001;93(13):979–89.

    Article  CAS  Google Scholar 

  5. Ebctcg, McGale P, Taylor C, Correa C, Cutter D, Duane F, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383(9935):2127–35.

    Article  Google Scholar 

  6. Harbeck N, Thomssen C, Gnant M. St. Gallen 2013: brief preliminary summary of the consensus discussion. Breast Care (Basel). 2013;8(2):102–9.

    Article  Google Scholar 

  7. Recht A, Comen EA, Fine RE, Fleming GF, Hardenbergh PH, Ho AY, et al. Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. J Clin Oncol. 2016;34(36):4431–42.

    Article  Google Scholar 

  8. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Breast Cancer, Version 1; 2018.

    Google Scholar 

  9. Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med. 1997;337(14):949–55.

    Article  CAS  Google Scholar 

  10. Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet. 1999;353(9165):1641–8.

    Article  CAS  Google Scholar 

  11. Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson KS, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst. 2005;97(2):116–26.

    Article  Google Scholar 

  12. Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373(4):307–16.

    Article  CAS  Google Scholar 

  13. Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015;373(4):317–27.

    Article  CAS  Google Scholar 

  14. Marinovich ML, Houssami N, Macaskill P, Sardanelli F, Irwig L, Mamounas EP, et al. Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. J Natl Cancer Inst. 2013;105(5):321–33.

    Article  CAS  Google Scholar 

  15. Park SH, Kim MJ, Park BW, Moon HJ, Kwak JY, Kim EK. Impact of preoperative ultrasonography and fine-needle aspiration of axillary lymph nodes on surgical management of primary breast cancer. Ann Surg Oncol. 2011;18(3):738–44.

    Article  Google Scholar 

  16. Oh JL, Nguyen G, Whitman GJ, Hunt KK, Yu TK, Woodward WA, et al. Placement of radiopaque clips for tumor localization in patients undergoing neoadjuvant chemotherapy and breast conservation therapy. Cancer. 2007;110(11):2420–7.

    Article  Google Scholar 

  17. Early Breast Cancer Trialists’ Collaborative Group. Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018;19(1):27–39.

    Article  Google Scholar 

  18. Rusthoven CG, Rabinovitch RA, Jones BL, Koshy M, Amini A, Yeh N, et al. The impact of postmastectomy and regional nodal radiation after neoadjuvant chemotherapy for clinically lymph node-positive breast cancer: a National Cancer Database (NCDB) analysis. Ann Oncol. 2016;27(5):818–27.

    Article  CAS  Google Scholar 

  19. Mamounas EP, Anderson SJ, Dignam JJ, Bear HD, Julian TB, Geyer CE Jr, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol. 2012;30(32):3960–6.

    Article  Google Scholar 

  20. Fowble BL, Einck JP, Kim DN, McCloskey S, Mayadev J, Yashar C, et al. Role of postmastectomy radiation after neoadjuvant chemotherapy in stage II-III breast cancer. Int J Radiat Oncol Biol Phys. 2012;83(2):494–503.

    Article  Google Scholar 

  21. Gillon P, Touati N, Breton-Callu C, Slaets L, Cameron D, Bonnefoi H. Factors predictive of locoregional recurrence following neoadjuvant chemotherapy in patients with large operable or locally advanced breast cancer: an analysis of the EORTC 10994/BIG 1–00 study. Eur J Cancer. 2017;79:226–34.

    Article  Google Scholar 

  22. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106.

    Article  CAS  Google Scholar 

  23. Garg AK, Strom EA, McNeese MD, Buzdar AU, Hortobagyi GN, Kuerer HM, et al. T3 disease at presentation or pathologic involvement of four or more lymph nodes predict for locoregional recurrence in stage II breast cancer treated with neoadjuvant chemotherapy and mastectomy without radiotherapy. Int J Radiat Oncol Biol Phys. 2004;59(1):138–45.

    Article  Google Scholar 

  24. Garg AK, Oh JL, Oswald MJ, Huang E, Strom EA, Perkins GH, et al. Effect of postmastectomy radiotherapy in patients <35 years old with stage II-III breast cancer treated with doxorubicin-based neoadjuvant chemotherapy and mastectomy. Int J Radiat Oncol Biol Phys. 2007;69(5):1478–83.

    Article  CAS  Google Scholar 

  25. Voduc KD, Cheang MC, Tyldesley S, Gelmon K, Nielsen TO, Kennecke H. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol. 2010;28(10):1684–91.

    Article  Google Scholar 

  26. Yu TME, Nagar H, Gomez P, Strom EA, Perkins GH, et al. Local-regional recurrences with and without radiation after neoadjuvant chemotherapy and mastectomy for T1–2/N0–1 breast cancer patients (abstract). Int J Radiat Oncol Biol Phys. 2008;72:S88–9.

    Article  Google Scholar 

  27. McGuire SE, Gonzalez-Angulo AM, Huang EH, Tucker SL, Kau SW, Yu TK, et al. Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys. 2007;68(4):1004–9.

    Article  Google Scholar 

  28. Yadav BS, Sharma SC, Singh R, Singh G. Patterns of relapse in locally advanced breast cancer treated with neoadjuvant chemotherapy followed by surgery and radiotherapy. J Cancer Res Ther. 2007;3(2):75–80.

    Article  CAS  Google Scholar 

  29. Huang EH, Tucker SL, Strom EA, McNeese MD, Kuerer HM, Buzdar AU, et al. Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy. J Clin Oncol. 2004;22(23):4691–9.

    Article  Google Scholar 

  30. Wright JL, Takita C, Reis IM, Zhao W, Saigal K, Wolfson A, et al. Predictors of locoregional outcome in patients receiving neoadjuvant therapy and postmastectomy radiation. Cancer. 2013;119(1):16–25.

    Article  Google Scholar 

  31. Settle SG-AA, Buchholz TA, Woodward WA, Yu TK, Oh JL, et al. Locoregional outcomes and radiotherapy response in patients with triple negative breast cancer (abstract). Int J Radiat Oncol Biol Phys. 2009;75:S9–10.

    Article  Google Scholar 

  32. Le Scodan R, Selz J, Stevens D, Bollet MA, de la Lande B, Daveau C, et al. Radiotherapy for stage II and stage III breast cancer patients with negative lymph nodes after preoperative chemotherapy and mastectomy. Int J Radiat Oncol Biol Phys. 2012;82(1):e1–7.

    Article  Google Scholar 

  33. Buchholz TA, Katz A, Strom EA, MD MN, Perkins GH, Hortobagyi GN, et al. Pathologic tumor size and lymph node status predict for different rates of locoregional recurrence after mastectomy for breast cancer patients treated with neoadjuvant versus adjuvant chemotherapy. Int J Radiat Oncol Biol Phys. 2002;53(4):880–8.

    Article  Google Scholar 

  34. Shim SJ, Park W, Huh SJ, Choi DH, Shin KH, Lee NK, et al. The role of postmastectomy radiation therapy after neoadjuvant chemotherapy in clinical stage II-III breast cancer patients with pN0: a multicenter, retrospective study (KROG 12–05). Int J Radiat Oncol Biol Phys. 2014;88(1):65–72.

    Article  Google Scholar 

  35. Buchholz TA, Tucker SL, Masullo L, Kuerer HM, Erwin J, Salas J, et al. Predictors of local-regional recurrence after neoadjuvant chemotherapy and mastectomy without radiation. J Clin Oncol. 2002;20(1):17–23.

    Article  CAS  Google Scholar 

  36. Daveau C, Stevens D, Brain E, Berges O, Villette S, Moisson P, et al. Is regional lymph node irradiation necessary in stage II to III breast cancer patients with negative pathologic node status after neoadjuvant chemotherapy? Int J Radiat Oncol Biol Phys. 2010;78(2):337–42.

    Article  Google Scholar 

  37. Bellon JR, Wong JS, Burstein HJ. Should response to preoperative chemotherapy affect radiotherapy recommendations after mastectomy for stage II breast cancer? J Clin Oncol. 2012;30(32):3916–20.

    Article  Google Scholar 

  38. White J, Mamounas E. Locoregional radiotherapy in patients with breast cancer responding to neoadjuvant chemotherapy: a paradigm for treatment individualization. J Clin Oncol. 2014;32(6):494–5.

    Article  Google Scholar 

  39. Rutgers EJDM, Straver ME, Meijnen P, CJH VDV, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer patients: final analysis of the EORTC AMAROS trial (10981/22023). J Clin Oncol ASCO Annual Meeting Abstracts. 2013;31(15). suppl: abstract LBA1001

    Article  Google Scholar 

  40. Marks LB, Prosnitz LR. Reducing local therapy in patients responding to preoperative systemic therapy: are we outsmarting ourselves? J Clin Oncol. 2014;32(6):491–3.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University of Health Sciences, Okmeydanı Training and Research Hospital, Istanbul, Turkey

    Makbule Tambas

  2. Istanbul University Faculty of Medicine, Department of Radiation Oncology, Istanbul, Turkey

    Kamuran Arslan Ibis & Merdan Fayda

Authors
  1. Makbule Tambas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kamuran Arslan Ibis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Merdan Fayda
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Oncology Institute, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    Adnan Aydiner

  2. Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    Abdullah Igci

  3. Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Magee-Women’s Hospital of UPMC, Pittsburgh, PA, USA

    Atilla Soran

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tambas, M., Ibis, K.A., Fayda, M. (2019). Adjuvant Radiation Therapy After Preoperative Chemotherapy. In: Aydiner, A., Igci, A., Soran, A. (eds) Breast Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-16792-9_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16792-9_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16791-2

  • Online ISBN: 978-3-030-16792-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation