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Clinical Trial
. 2010 Dec;124(3):723-32.
doi: 10.1007/s10549-010-1181-8. Epub 2010 Sep 29.

Preoperative concurrent paclitaxel-radiation in locally advanced breast cancer: pathologic response correlates with five-year overall survival

Sylvia Adams  1 , A Bapsi Chakravarthy, Martin Donach, Darcy Spicer, Stella Lymberis, Baljit Singh, Joshua A Bauer, Tsivia Hochman, Judith D Goldberg, Franco Muggia, Robert J Schneider, Jennifer A Pietenpol, Silvia C Formenti
Affiliations
Clinical Trial

Preoperative concurrent paclitaxel-radiation in locally advanced breast cancer: pathologic response correlates with five-year overall survival

Sylvia Adams et al. Breast Cancer Res Treat. 2010 Dec.

Abstract

We have previously demonstrated high pathologic response rates after neoadjuvant concurrent chemoradiation in patients with locally advanced breast cancer (LABC). We now report disease-free survival (DFS) and overall survival (OS) in the context of pathologic response. 105 LABC patients (White 46%, Non-White 54%) were treated with paclitaxel (30 mg/m² intravenously twice a week) for 10-12 weeks. Daily radiotherapy was delivered to breast, axillary, and supraclavicular lymph nodes during weeks 2-7 of paclitaxel treatment, at 1.8 Gy per fraction to a total dose of 45 Gy with a tumor boost of 14 Gy at 2 Gy/fraction. Pathological complete response (pCR) was defined as the absence of invasive cancer in breast and lymph nodes and pathological partial response (pPR) as the persistence of <10 microscopic foci of invasive carcinoma in breast or lymph nodes. Pathologic response (pCR and pPR) after neoadjuvant chemoradiation was achieved in 36/105 patients (34%) and was associated with significantly better DFS and OS. Pathological responders had a lower risk of recurrence or death (HR = 0.35, P = 0.01) and a longer OS (HR = 4.27, P = 0.01) compared with non-responders. Median DFS and OS were 57 and 84 months for non-responders, respectively, and have not yet been reached for responders. Importantly, pathologic response was achieved in 54% of patients with HR negative tumors (26/48). In conclusion, pathologic response to concurrent paclitaxel-radiation translated into superior DFS and OS. Half of the patients with HR negative tumors achieved a pathologic response.

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Figures

Fig. 1
Fig. 1
Treatment schema
Fig. 2
Fig. 2
Overall survival and disease-free survival for the entire cohort
Fig. 3
Fig. 3
Kaplan Meier estimates of overall survival and disease-free survival a DFS by pathologic response for entire cohort, b DFS by pathologic response and HR status, c OS by pathologic response for entire cohort, and d OS by pathologic response and HR status. HR hormone receptor, pCR pathologic complete response, pPR pathologic partial response, pNR no pathologic response
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