Abstract
BackgroundIt has been demonstrated that postmastectomy radiation therapy (PMRT) was beneficial for breast cancer patients who are axillary lymph node-positive. However, the effectiveness of radiotherapy in pathological negative nodes (ypN0) after neoadjuvant chemotherapy (NAC) remains open to considerable debate. Here, we aim to evaluate whether PMRT improves loco-regional control and survival for such patients.MethodsThe literature from January 2004 to June 2019 was searched. The effects of PMRT on local-regional recurrence (LRR) and survival was evaluated in a meta-analysis. Pooled relative risk (RR) values with 95% confidence intervals (CIs) were computed using random and fixed-effect model. Subgroup and heterogeneity analyses were also conducted.ResultsTwelve studies that included 17,747 patients met the inclusion criteria. Pooled results showed that PMRT was associated with reduced LRR (RR, 0.38; 95% CI, 0.19–0.77, P = 0.007), particularly in patients with stage III breast cancer (RR, 0.16; 95% CI, 0.07–0.37, P < 0.001). However, no significant difference in disease-free survival were observed with the addition of PMRT for ypN0 patients (RR, 0.70; 95% CI, 0.21–2.27, P = 0.55). Also, there was no statistically significant association between radiotherapy with overall survival (RR, 0.81; 95% CI, 0.64–1.04, P = 0.10).ConclusionsOur meta-analysis indicated that PMRT might reduce local-regional recurrence for ypN0 patients after NAC, but lack of benefit for survival outcomes. Prospective randomized clinical trial data will be needed to confirm our results.
Highlights
It has been demonstrated that postmastectomy radiation therapy (PMRT) was beneficial for breast cancer patients who are axillary lymph node-positive
1165 were excluded after screening of titles and abstracts. Another 184 studies were excluded for the following reasons: they were laboratory studies or irrelevant studies, study sample sizes were too small, and they were duplicate articles or provided no local-regional recurrence (LRR) or survival outcome data
We evaluated the association between PMRT and LRR in the entire group and in subgroups to determine their contribution
Summary
It has been demonstrated that postmastectomy radiation therapy (PMRT) was beneficial for breast cancer patients who are axillary lymph node-positive. Postmastectomy radiation therapy (PMRT) have shown significantly reduces recurrence in patients with positive lymph nodes after following systemic treatment [3,4,5]. The discrepancy in the response to NAC complicates the adjuvant setting treatment decision, and the role of PMRT in breast cancer with no evidence of residual pathologic nodal disease (ypN0) has remained controversial. Several retrospective studies found that PMRT was associated with improving both local control and survival in ypN0 breast cancer patients [6,7,8]. A recent analysis reported that PMRT reduced local-regional recurrence (LRR) in ypN0 breast cancer cases, following primary systemic treatment [9]. The results implied that there was no increase in the risk of LRR when PMRT was omitted
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