Abstract Backgroud: Neoadjuvant radiotherapy (NRT) is generally recommended after systemic therapy for inoperable stage III breast cancer. At the BCCA, neoadjuvant radiation is also frequently offered for patients with operable node positive disease after neoadjuvant chemotherapy. There is a lack of randomised trial data comparing outcomes in stage II/III breast cancer when radiation therapy is delivered neoadjuvantly versus adjuvantly. Aim: The primary objective of this study is to assess the clinical outcomes, as measured by relapse-free survival (RFS), overall survival (OS), and breast cancer-specific survival (BCSS), of women with stage II/III breast cancer treated with neoadjuvant chemotherapy and either neoadjuvant or adjuvant radiotherapy. Methods: Patients were identified by linking the Breast Cancer Outcomes Unit (BCOU) with the British Columbia Cancer Agency Pharmacy data repository. Inclusion criteria included: Female, referred to BCCA with newly diagnosed disease, clinical stage II or III breast cancer, neoadjuvant chemotherapy, breast surgery performed as part of the initial treatment plan, RT (given adjuvantly or neo-adjuvantly to the breast/chest wall +/− regional nodes). Patients were excluded if they had a previous or synchronous in situ or invasive breast cancer. Demographic data, treatment characteristics, ER, PR and HER-2 status (when available) were extracted. Data was analyzed using descriptive statistics and Kaplan Méier curves survival analyses were produced using SPSS, V. 14. Results: Between Jan 1, 1995 and Dec 31, 2008, 687 patients with stage II/III disease were identified. 394 patients received neo-adjuvant and 293 patients received adjuvant radiation. Patients treated with neoadjuvant vs. adjuvant RT differed in age (median: 51yrs vs. 49yrs, p < 0.001), margin status (86.5% negative/5.1% positive/ 8.4% unknown vs. 94.2% negative/1.7% positive/4.1% unknown, p = 0.02), surgery (94.2% vs. 87.7% mastectomy, p = 0.003), and type of chemotherapy (50.3% vs. 24.6% anthracycline only, p < 0.001) respectively. No differences in 5-year RFS (60.0 vs. 64.8 %, respectively, p = 0.07), 5 year BCSS (67.9 vs. 73.1 %, respectively p = 0.17) and 5-year OS (66.2 vs. 72.5 %, respectively, p = 0.06) were seen in the neoadjuvant vs. adjuvant population. Conclusion: Within the limitations of this retrospective study, the sequence of use of radiation pre-operative compared to post-operative following neoadjuvant chemotherapy appears to have similar clinical outcomes. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-16-04.
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