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Role of Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer Patients: A Study from the Japanese Breast Cancer Registry

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The role of postmastectomy radiotherapy (PMRT) in breast cancer patients receiving neoadjuvant chemotherapy (NAC) is controversial. We aimed to evaluate the effectiveness of radiotherapy in patients treated with NAC and mastectomy in the Japanese Breast Cancer Registry.

Methods

We enrolled patients who received NAC and mastectomy for cT1–4 cN0–2 M0 breast cancer. We evaluated the association between radiotherapy and outcomes, locoregional recurrence (LRR), distant disease-free survival (DDFS), and overall survival (OS) based on ypN status by multivariable analysis.

Results

Of the 145,530 patients, we identified 3226 who met the inclusion criteria. Among ypN1 patients, no differences were found in LRR, DDFS, or OS between groups with and without radiotherapy (p = 0.72, p = 0.29, and p = 0.36, respectively). Radiotherapy was associated with improved LRR-free survival (p < 0.001), DDFS (p = 0.01), and OS (p < 0.001) in patients with ypN2–3. Multivariable analysis demonstrated that use of radiotherapy was independently associated with improved LRR [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.45–0.82, p = 0.001] and OS [HR 0.69, 95% CI 0.53–0.89, p = 0.004) for ypN2–3 patients only. The association between radiotherapy and OS was not statistically significant among ypN0 (p = 0.22) and ypN1 patients (p = 0.51).

Conclusions

The results from this nationwide database study did not show significant associations between PMRT and improved survival among ypN0 and ypN1 patients. Radiotherapy may be beneficial only for ypN2–3 breast cancer patients who receive NAC and mastectomy in the modern era.

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Acknowledgment

We thank the JBCS for their grant support to perform the present study. We also thank the affiliated institutes participating in the Japanese Breast Cancer Registry of the JBCS for their efforts to register patients’ data.

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Authors and Affiliations

  1. Department of Breast and Endocrine Surgical Oncology, Tohoku University School of Medicine, Sendai, Japan

    Minoru Miyashita MD, PHD & Takanori Ishida MD, PHD

  2. Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Isehara, Japan

    Naoki Niikura MD, PHD & Yutaka Tokuda MD, PHD

  3. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hiraku Kumamaru MD, PHD

  4. Department of Health Policy and Management School of Medicine, Keio University, Tokyo, Japan

    Hiroaki Miyata MD, PHD

  5. Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan

    Takayuki Iwamoto MD, PHD

  6. Department of Breast Surgery, Miyagi Cancer Center, Natori, Japan

    Masaaki Kawai MD, PHD

  7. Department of Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan

    Keisei Anan MD, PHD

  8. Department of Breast Surgical Oncology, St. Luke’s International Hospital, Tokyo, Japan

    Naoki Hayashi MD, PHD

  9. Department of Breast Surgery, Shikoku Cancer Center, Matsuyama, Japan

    Kenjiro Aogi MD, PHD

  10. Sapporo-Kotoni Breast Clinic, Sapporo, Japan

    Hideji Masuoka MD, PHD

  11. Department of Breast Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Kotaro Iijima MD, PHD

  12. Department of Pathology, Nihon University School of Medicine, Tokyo, Japan

    Shinobu Masuda MD, PHD

  13. Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine, Kawasaki, Japan

    Koichiro Tsugawa MD, PHD

  14. Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan

    Takayuki Kinoshita MD, PHD

  15. Department of Basic Pathology, National Defense Medical College, Saitama, Japan

    Hitoshi Tsuda MD, PHD

  16. Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan

    Seigo Nakamura MD, PHD

Authors
  1. Minoru Miyashita MD, PHD
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  2. Naoki Niikura MD, PHD
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  3. Hiraku Kumamaru MD, PHD
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  4. Hiroaki Miyata MD, PHD
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  5. Takayuki Iwamoto MD, PHD
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  6. Masaaki Kawai MD, PHD
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  7. Keisei Anan MD, PHD
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  8. Naoki Hayashi MD, PHD
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  9. Kenjiro Aogi MD, PHD
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  10. Takanori Ishida MD, PHD
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  11. Hideji Masuoka MD, PHD
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  12. Kotaro Iijima MD, PHD
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  13. Shinobu Masuda MD, PHD
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  14. Koichiro Tsugawa MD, PHD
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  15. Takayuki Kinoshita MD, PHD
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  16. Hitoshi Tsuda MD, PHD
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  17. Seigo Nakamura MD, PHD
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  18. Yutaka Tokuda MD, PHD
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Corresponding author

Correspondence to Minoru Miyashita MD, PHD.

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Disclosure

Drs. Kumamaru and Miyata are affiliated with the department of Healthcare Quality Assessment at the University of Tokyo, which is a social collaboration department supported by National Clinical Database, Johnson & Johnson KK., and Nipro corporation. The other authors declare no conflicts of interest.

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Miyashita, M., Niikura, N., Kumamaru, H. et al. Role of Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer Patients: A Study from the Japanese Breast Cancer Registry. Ann Surg Oncol 26, 2475–2485 (2019). https://doi.org/10.1245/s10434-019-07453-1

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  • DOI: https://doi.org/10.1245/s10434-019-07453-1

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