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. 2017 Jun 30;19(1):75.
doi: 10.1186/s13058-017-0870-1.

Neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival

Jan Poleszczuk  1   2 , Kimberly Luddy  3 , Lu Chen  4 , Jae K Lee  4 , Louis B Harrison  5 , Brian J Czerniecki  6 , Hatem Soliman  7 , Heiko Enderling  8   9
Affiliations

Neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival

Jan Poleszczuk et al. Breast Cancer Res. .

Abstract

Background: Compared with surgery alone, postoperative adjuvant radiotherapy (RT) improves relapse-free survival of patients with early-stage breast cancer. We evaluated the long-term overall and disease-free survival rates of neoadjuvant (presurgical) versus adjuvant RT in early-stage breast cancer patients.

Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database provided by the National Institutes of Health to derive an analytic dataset of 250,195 female patients with early-stage breast cancer who received RT before (n = 2554; 1.02%) or after (n = 247,641; 98.98%) surgery. Disease-free survival, defined as time to diagnosis of a second primary tumor at any location, was calculated from automated patient identification matching of all SEER records.

Results: Partial and complete mastectomies were performed in 94.4% and 5.6% of patients, respectively. In the largest cohort of estrogen receptor-positive women who underwent partial mastectomy, the HR of developing a second primary tumor after neoadjuvant compared with adjuvant RT was 0.64 (95% CI 0.55-0.75; P < 0.0001). Overall survival was independent of radiation sequence (HR 1; P = 0.95). Neoadjuvant RT also resulted in a lower HR for second primary cancer among estrogen receptor-positive patients who underwent mastectomy compared with those who received adjuvant RT (HR 0.48, 95% CI 0.26-0.87; P = 0.0162).

Conclusions: Neoadjuvant RT may significantly improve disease-free survival without reducing overall survival, especially for estrogen receptor-positive patients with early-stage breast cancer. This finding warrants further exploration of potential long-term benefits of neoadjuvant radiotherapy for early-stage breast cancer in a controlled, prospective clinical trial setting, with correlative studies done to identify potential mechanisms of superiority.

Keywords: Disease-free survival; Early-stage breast cancer; Immune response; Overall survival; Postoperative radiotherapy; Preoperative radiotherapy.

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Study enrollment. Of 1,300,604 female breast cancer records present in the Surveillance, Epidemiology, and End Results database, 2554 patients who had radiotherapy (RT) before surgery (neoadjuvant RT) and 247,641 patients who had RT after surgery (adjuvant RT) were included in the analysis
Fig. 2
Fig. 2
HRs of developing second primary tumors calculated from a multivariate Cox proportional hazards model. a Patients who underwent breast-conserving surgery. b Patients who underwent mastectomy. Shown are HRs, 95% CIs, and P values. n Total number of patients in each cohort, I Number of patients who received neodjuvant radiotherapy (RT) in each cohort, ER Estrogen receptor
Fig. 3
Fig. 3
Survival curves for estrogen receptor-positive patients after partial mastectomy. Shown are (a) cancer-free and (b) overall survival curves with 95% CIs. RT radiotherapy
Fig. 4
Fig. 4
HRs of death calculated from a multivariate Cox proportional hazards model for patients diagnosed with estrogen-positive tumors who underwent breast-conserving surgery. Shown are HRs, 95% CIs, and P values. PR Progesterone receptor
See this image and copyright information in PMC

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