Locoregional Recurrence with Breast Conservation Surgery and Radiotherapy after Neoadjuvant Chemotherapy.

Abstract

Abstract Purpose; Breast conservation surgery (BCS) and radiotherapy(RT) after neoadjuvant chemotherapy (NEO) has concerns of high locoregional recurrence (LRR) rates. This analysis was done to know LRR rates and the variables increasing LRRs.Patients and Methods; 242 breast cancer patients treated with BCS and RT after NEO between 2001 and 2006 were included in this study. All patients were clinically node positive by positron emission tomography. Clinical stage at diagnosis (2003 AJCC) was IIA in 22.7%, IIB in 43.0%, IIIA in 33.5% and IIIB in 0.8% of patients. Of the patients, 51.4% received anthracycline-based NEO, 34.2% received a taxane, and 14.4% received anthracycline combined taxane regimen. RT was done to all patients.Results; At a median follow-up of 56 months (range, 14 - 86 months), 24 patients (9.9%) had developed LRR. Among these, 18 (7.4%) were ipsilateral breast tumor recurrences (IBTR), 2(0.8%) axilla, 3 (1.2%) supraclavicular and 5 (2.1%) internal mammary recurrences. Five-year actuarial rates of IBTR-free and LRR-free survival were 86.9% and 84.4%, respectively. Distant metastases were detected in 36 patients (14.9%). On multivariate analyses of LRR, adjuvant hormone therapy, pathological lymph node status and clinical stage were associated with higher rates of LRR. The hazard ratios for lack of hormone therapy, pathological nodal stage N2-3, and clinical stage III were 8.9 (95% CI, 3.5 to 23.1; p<0.0001), 4.3 (95% CI, 1.7 to 11.2; p=0.003) and 2.7 (95% CI, 1.1 to 6.5; p=0.02), respectively. 5-year actuarial LRR-free survival rate was 86.5% in patients with adjuvant hormone therapy while it was 76.8% in patients without adjuvant hormone therapy.Conclusion; BCS with RT after NEO results in acceptably low rates of IBTR and LRR in clinical node positive patients. The adjuvant hormone therapy, pathologic lymph node status and clinical stages predict higher rates of LRR. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4120.