Patterns of Locoregional Recurrence in Breast Cancer Patients After Neoadjuvant Chemotherapy and Adjuvant Radiation Therapy

Abstract

Neoadjuvant chemotherapy is considered a viable option for patients with palpable breast cancer. There is limited information about patterns of locoregional recurrence (LRR) in breast cancer patients after neoadjuvant chemotherapy (NC), which has resulted in difficult identification of the rates and the predictors of LRR after NC. The main objective of this study is to determine the patterns of locoregional failure in breast cancer patients who received NC and adjuvant radiation. This is a retrospective analysis including 811women who received different chemotherapeutic agents as NC for stage I, II&III breast cancer and treated between 1997 and 2014. The patients’ median age was 49.2 (range 24.3-83.7 years). 28 patients (3.4%) were diagnosed with stage I, 479 (61.2%) with stage II, 229 (28.2%) with stage III and 58 (7.1%) with no preoperative staging. 391 patients underwent lumpectomy (48.2 %) while 417 (51.4%) underwent mastectomy and 3 didn't undergo any surgery. 196 (24.2%) showed pathological complete response pCR, 566 (69.8%) with pathological partial response (pPR), 38 (4.7%) with pathological no response/progression (pNR) while 11 (0.1%) were not assessed for pathological response. 722 (89%) patients received radiotherapy and 83 (10.2%) did not. In 6 patients (0.4%) there was no available data on their radiation treatment. Factors associated with LRR were assessed utilizing the Kaplan-Meier method and Logistic regression model. The median follow up period for all patients was 66.5 months. The rate of LRR was 5.1% at 5 years and 9% at 10 years. The overall and disease-free survival rates at five were (89.1%), (83.1%) respectively and at ten years were (80.9%) (68.7%) respectively. 184 patients (22.7%) developed distant metastasis and 52(7%) developed LRR. The median time for LRF was 1.5 years. 69% of LRF occurred in breast and or chest wall, 10% in axilla, and 15.4% in supraclavicular area and 5.6 in other sites. We found that LRR was significantly associated with the presence of lymph-vascular invasion (LVI) at the time of surgery (P=0.008). We also noticed that the rate of LRR was higher among patients who had pNR (P=0.02). Other factors as age, tumor pathology and type of surgery were not significant. These data suggest that the presence of LVI and pNR at the time of surgery after NC is associated with a significantly higher rate of LRR, and both can be considered as predictors for local failure after NC.