Abstract
Introduction: Radiotherapy (RT) plays an indispensable role in postoperative breast cancer treatment. This study aimed to assess the feasibility of preoperative RT for stage III breast cancer by comparing preoperative RT with postoperative RT in terms of overall survival (OS). Methods: Based on the information in the Surveillance, Epidemiology, and End Results database from 2000 to 2018, patients with stage III breast cancer who had undergone radical surgery and RT were divided into two groups: a preoperative RT group and a postoperative RT group. OS was calculated using Kaplan-Meier analysis. The Cox proportional hazards model was used to evaluate independent factors associated with OS. Propensity score matching (PSM) was used to balance stratification factors. Results: In total, 9,605 patients were enrolled, of whom 9,456 received postoperative RT and 149 received preoperative RT. After a median follow-up of 72 months, postoperative RT was found to be superior to preoperative RT in terms of OS (p < 0.000). Compared to the postoperative RT group, the preoperative RT group showed a significantly higher risk of overall mortality without PSM in univariate (OS: hazard ratio [HR] = 1.653, 95% confidence interval [CI]: 1.288–2.123, p < 0.000) and multivariate analyses (OS: HR = 1.409, 95% CI: 1.096–1.810, p = 0.007). After PSM, the OS of the postoperative RT group was superior to the OS in the preoperative RT group (p = 0.041). Compared with the postoperative RT group, the preoperative RT group showed a significantly higher risk of overall mortality without PSM in univariate (HR = 1.312, 95% CI: 1.010–1.704, p = 0.042) and multivariate analyses (HR = 1.466, 95% CI: 1.127–1.906, p = 0.004). Conclusion: Preoperative RT does not improve OS in patients with stage III breast cancer and has a worse prognosis. Preoperative RT has not changed the existing treatment paradigm in the current therapeutic context for patients with stage III breast cancer.
Journal Section:
Clinical Study
References
1.
Clarke
M
, Collins
R
, Darby
S
, Davies
C
, Elphinstone
P
, Evans
V
et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials
. Lancet
. 2005
;366
(9503
):2087
–106
.2.
Early Breast Cancer Trialists’ Collaborative Group EBCTCG
Darby
S
, McGale
P
, Correa
C
, Taylor
C
, Arriagada
R
et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials
. Lancet
. 2011 Nov 12
378
9804
1707
16
Epub 2011 Oct 19. 3.
Whelan
TJ
, Olivotto
IA
, Parulekar
WR
, Ackerman
I
, Chua
BH
, Nabid
A
et al. Regional nodal irradiation in early-stage breast cancer
. N Engl J Med
. 2015
;373
(4
):307
–16
.4.
EBCTCG Early Breast Cancer Trialists’ Collaborative Group
McGale
P
, Taylor
C
, Correa
C
, Cutter
D
, Duane
F
et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8,135 women in 22 randomised trials
. Lancet
. 2014 Jun 21
383
9935
2127
35
Epub 2014 Mar 19. 5.
Liedtke
C
, Mazouni
C
, Hess
KR
, André
F
, Tordai
A
, Mejia
JA
et al. Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer
. J Clin Oncol
. 2008 Mar10
26
8
1275
81
Epub 2008 Feb 4. 6.
Cortazar
P
, Zhang
L
, Untch
M
, Mehta
K
, Costantino
JP
, Wolmark
N
et al. Pathological complete response and long term clinical benefit in breast cancer: the CTNeoBC pooled analysis
. Lancet
. 2014 Jul 12
384
9938
164
72
Epub 2014 Feb 14. 7.
von Minckwitz
G
, Untch
M
, Blohmer
Jens-U
, Costa
SD
, Eidtmann
H
, Fasching
PA
et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes
. J Clin Oncol
. 2012 May 20
30
15
1796
804
Epub 2012 Apr 16. 8.
Pazos
M
, Corradini
S
, Dian
D
, von Bodungen
V
, Ditsch
N
, Wuerstlein
R
et al. Neoadjuvant radiotherapy followed by mastectomy and immediate breast reconstruction: an alternative treatment option for locally advanced breast cancer
. Strahlenther Onkol
. 2017 Apr
193
4
324
31
Epub 2017 Jan 25. 9.
Kaidar-Person
O
, Vrou Offersen
B
, Hol
S
, Arenas
M
, Aristei
C
, Bourgier
C
et al. ESTRO-ACROP consensus guideline for target volume delineation in the setting of postmastectomy radiation therapy after implant- based immediate reconstruction for early stage breast cancer
. Radiother Oncol
. 2019 Aug
137
159
66
Epub 2019 May 17. 10.
Ho
AY
, Patel
N
, Ohri
N
, Morrow
M
, Mehrara
BJ
, Disa
JJ
et al. Bilateral implant reconstruction does not affect the quality of postmastectomy radiation therapy
. Med.Dosim
. 2014 Mar 01
39
1
18
22
.11.
Bartelink
H
. The changing landscape in radiotherapy for breast cancer: lessons from long term follow-up in some European breast cancer trials
. Radiother Oncol
. 2016 Dec
121
3
348
56
Epub 2016 Nov 24. 12.
Recht
A
, Come
SE
, Henderson
IC
, Gelman
RS
, Silver
B
, Hayes
DF
et al. The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer
. N Engl J Med
. 1996 May 23
334
21
1356
61
.13.
Mladenovic
J
, Susnjar
S
, Tanic
M
, Jankovic
R
, Karadzic
K
, Gavrilovic
D
et al. Tumor response and patient outcome after preoperative radiotherapy in locally advanced non-inflammatory breast cancer patients
. J BUON
. 2017 Mar–Apr
22
2
325
33
.14.
Vasmel
JE
, Vreuls
CPH
, Manson
QF
, Charaghvandi
RK
, van Gorp
J
, van Leeuwen
AMG
et al. Tumor-infiltrating lymphocytes in low-risk patients with breast cancer treated with single dose preoperative partial breast irradiation
. Int J Radiat Oncol Biol Phys
. 2021 Apr 1
109
5
1325
31
Epub 2020 Dec 15. 15.
Poggio
F
, Lambertini
M
, de Azambuja
E
. Controversis in oncology: surgery of the primary tumour in patients presenting with de novo metastatic breast cancer: to do or not to do
. ESMO Open
. 2018 Jan 27
3
1
e000324
.16.
Cardoso
F
, Paluch-Shimon
S
, Senkus
E
, Curigliano
G
, Aapro
MS
, André
F
et al. 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5)
. Ann Oncol
. 2020 Dec
31
12
1623
49
Epub 2020 Sep 23. 17.
Finkelstein
SE
, Timmerman
R
, McBride
WH
, Schaue
D
, Hoffe
SE
, Mantz
CA
et al. The confluence of stereotactic ablative radiotherapy and tumor immunology
. Clin Dev Immunol
. 2011
;2011
:439752
.18.
Poleszczuk
JT
, Luddy
KA
, Prokopiou
S
, Robertson-Tessi
M
, Moros
EG
, Fishman
M
et al. Abscopal benefits of localized radiotherapy depend on activated T-cell trafficking and distribution between metastatic lesions
. Cancer Res
. 2016 Mar.1
76
5
1009
18
.19.
Burnette
B
, Weichselbaum
RR
. Radiation as an immune modulator seminars in radiation oncology
. Semin Radiat Oncol
. 2013 Oct
23
4
273
80
.20.
Formenti
SC
, Demaria
S
. Radiation therapy to convert the tumor into an in situ vaccine
. Int J Radiat Oncol Biol Phys
. 2012
;84
(4
):879
–80
.21.
Deng
Y
, Li
H
, Zheng
Y
, Zhai
Z
, Wang
M
, Lin
S
et al. Impact of preoperative vs. Postoperative radiotherapy on overall survival of locally advanced breast cancer patients
. Front Oncol
. 2021 Nov 23
11
779185
.22.
Zhang
Y
, Xu
Z
, Chen
H
, Sun
X
, Zhang
Z
. Survival comparison between postoperative and preoperative radiotherapy for stage I–III non-inflammatory breast cancer
. Sci Rep
. 2022
;12
(1
):14288
.23.
Poleszczuk
J
, Luddy
K
, Chen
L
, Lee
JK
, Harrison
LB
, Czerniecki
BJ
et al. Neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival
. Breast Cancer Res
. 2017 Jun 30
19
1
75
.24.
Palta
M
, Yoo
S
, Adamson
JD
, Prosnitz
LR
, Horton
JK
. Preoperative single fraction partial breast radiotherapy for early-stage breast cancer
. Int J Radiat Oncol Biol Phys
. 2012
;82
(1
):37
–42
.25.
Sikov
WM
, Berry
DA
, Perou
CM
, Singh
B
, Cirrincione
CT
, Tolaney
SM
et al. Impact of the addition of carboplatin and/or bevacizumab to neoadjuvant once-per-week paclitaxel followed by dose-dense doxorubicin and cyclophosphamide on pathologic complete response rates in stage II to III triple-negative breast cancer: CALGB 40603 (alliance)
. J Clin Oncol
. 2015 Jan 1
33
1
13
21
Epub 2014 Aug 4. 26.
Schmid
P
, Cortes
J
, Pusztai
L
, McArthur
H
, Kümmel
S
, Bergh
J
et al. Pembrolizumab for early triple-negative breast cancer
. N Engl J Med
. 2020 Feb 27
382
9
810
21
.27.
Schneeweiss
A
, Chia
S
, Hickish
T
, Harvey
V
, Eniu
A
, Hegg
R
et al. Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: a randomized phase II cardiac safety study (TRYPHAENA)
. Ann Oncol
. 2013
;24
(9
):2278
–84
.28.
van Ramshorst
MS
, van der Voort
A
, van Werkhoven
ED
, Mandjes
IA
, Kemper
I
, Dezentjé
VO
et al. Neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2 blockade for HER2-positive breast cancer (TRAIN-2): a multicentre, open-label, randomised, phase 3 trial
. Lancet Oncol
. 2018 Dec
19
12
1630
40
Epub 2018 Nov 6. 29.
Johnston
SRD
, Harbeck
N
, Hegg
R
, Toi
M
, Martin
M
, Shao
ZM
et al. Abemaciclib combined with endocrine therapy for the adjuvant treatment of HR+, HER2-node-positive, high-risk, early breast cancer (monarch E)
. J Clin Oncol
. 2020 Dec 1
38
34
3987
98
. Epub 2020 Sep 20. 30.
Wang
X
, Wang
SS
, Huang
H
, Cai
L
, Zhao
L
, Peng
RJ
et al. Effect of capecitabine maintenance therapy using lower dosage and higher frequency vs observation on disease- free survival among patients with early-stage triple-negative breast cancer who had received standard treatment: the SYSUCC- 001 randomized clinical trial
. JAMA
. 2021 Jan 5
325
1
50
8
.31.
Masuda
N
, Lee
SJ
, Ohtani
S
, Im
YH
, Lee
ES
, Yokota
I
et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy
. N Engl J Med
. 2017 Jun 1
376
22
2147
59
.32.
Tutt
ANJ
, Garber
JE
, Kaufman
B
, Viale
G
, Fumagalli
D
, Rastogi
P
et al. Adjuvant olaparib for patients with BRCA1- or BRCA2-mutated breast cancer
. N Engl J Med
. 2021 Jun 24
384
25
2394
405
.33.
von Minckwitz
G
, Huang
CS
, Mano
MS
, Loibl
S
, Mamounas
EP
, Untch
M
et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer
. N Engl J Med
. 2019 Feb 14
380
7
617
28
.34.
Caudle
AS
, Gonzalez-Angulo
AM
, Hunt
KK
, Pusztai
L
, Kuerer
HM
, Mittendorf
EA
et al. Impact of progression during neoadjuvant chemotherapy on surgical management of breast cancer
. Ann Surg
. 2011Apr
18
4
932
8
.35.
Nozawa
K
, Takatsuka
D
, Endo
Y
, Horisawa
N
, Ozaki
Y
, Kataoka
A
et al. Impact of tumor progression on survival during neoadjuvant chemotherapy in breast cancer: a cohort study
. Anticancer Res
. 2022 Jul
42
7
3735
42
.36.
Riet
FG
, Fayard
F
, Arriagada
R
, Santos
MA
, Bourgier
C
, Ferchiou
M
et al. Preoperative radiotherapy in breast cancer patients: 32 years of follow-up
. Eur J Cancer
. 2017 May
76
45
51
Epub 2017 Mar 6. 37.
Montero
A
, Ciérvide
R
. Preoperative radio (chemo) therapy in breast cancer: time to switch the perspective
. Curr Oncol
. 2022 Dec 12
29
12
9767
87
.38.
Thiruchelvam
PTR
, Leff
DR
, Godden
AR
, Cleator
S
, Wood
SH
, Kirby
AM
et al. Primary radiotherapy and deep inferior epigastric perforator flap reconstruction for patients with breast cancer (PRADA): a multicentre, prospective, non-randomised, feasibility study
. Lancet Oncol
. 2022 May
23
5
682
90
Epub 2022 Apr 7. 39.
Tanić
M
, Krivokuća
A
, Čavić
M
, Mladenović
J
, Plesinac Karapandžić
V
, Beck
S
et al. Molecular signature of response to preoperative radiotherapy in locally advanced breast cancer
. Radiat Oncol
. 2018 Oct 1
13
1
193
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