Does internal mammary node irradiation affect treatment outcome in clinical stage II–III breast cancer patients receiving neoadjuv ant chemotherapy?

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• 作者：Kyung Hwan Kim ; Jae Myoung Noh ; Yong Bae Kim…
• 关键词：Internal mammary node irradiation ; Neoadjuvant chemotherapy ; Breast cancer
• 刊名：Breast Cancer Research and Treatment
• 出版年：2015
• 出版时间：August 2015
• 年：2015
• 卷：152
• 期：3
• 页码：589-599
• 全文大小：517 KB
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  6.Chang JS, Park W, Kim YB et al (2013) Long-term survival outcomes following internal mammary node irradiation in stage II-III breast cancer: results of a large retrospective study with 12-year follow-up. Int J Radiat Oncol Biol Phys 86(5):867-72. doi:10.-016/?j.?ijrobp.-013.-2.-37 PubMed View Article
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• 作者单位：Kyung Hwan Kim (1)
  Jae Myoung Noh (2)
  Yong Bae Kim (1)
  Jee Suk Chang (1)
  Ki Chang Keum (1)
  Seung Jae Huh (2)
  Doo Ho Choi (2)
  Won Park (2)
  Chang-Ok Suh (1)
  
  1. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
  2. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Republic of Korea
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Oncology
  
• 出版者：Springer Netherlands
• ISSN：1573-7217

文摘

The purpose of this study is to assess the value of internal mammary node irradiation (IMNI) in patients receiving postoperative radiotherapy after neoadjuvant chemotherapy (NAC) using modern systemic therapy. Between 2001 and 2009, 521 consecutive patients with clinical stage II–III breast cancer received NAC and postoperative radiotherapy. With a consistent policy, the treating radiation oncologist either included (N?=?284) or excluded (N?=?237) the internal mammary node in the treatment volume. Anthracycline- and taxane-based chemotherapy was provided to 482 (92.5?%) patients. To account for the unbalanced characteristics between the two groups, we performed propensity score matching and covariate adjustment using the propensity score. The median follow-up duration was 71?months (range 31-53?months). The 5-year disease-free survival (DFS) with and without IMNI was 81.8 and 72.7?%, respectively (p?=?0.019). The benefit of IMNI varied according to patient characteristics such that it was more apparent in patients with N1- disease, inner/central location, and triple-negative subtype. After adjusting for all potential confounding variables, IMNI was independently associated with improved DFS (p?=?0.049). The significant effect of IMNI on DFS was sustained after propensity score matching (p?=?0.040) and covariate adjustment using the propensity score (p?=?0.048). Symptomatic radiation pneumonitis developed in 9 (3.2?%) patients receiving IMNI. Our results indicated that IMNI was associated with a significant improvement in DFS with low toxicity rate for breast cancer patients receiving NAC. Further prospective studies are warranted to confirm the effect of IMNI in the NAC setting.