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Neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival
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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493088/ https://www.ncbi.nlm.nih.gov/pubmed/28666457 http://dx.doi.org/10.1186/s13058-017-0870-1 |
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author | Poleszczuk, Jan Luddy, Kimberly Chen, Lu Lee, Jae K. Harrison, Louis B. Czerniecki, Brian J. Soliman, Hatem Enderling, Heiko |
author_facet | Poleszczuk, Jan Luddy, Kimberly Chen, Lu Lee, Jae K. Harrison, Louis B. Czerniecki, Brian J. Soliman, Hatem Enderling, Heiko |
author_sort | Poleszczuk, Jan |
collection | PubMed |
description | 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13058-017-0870-1) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5493088 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-54930882017-06-30 Neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival Poleszczuk, Jan Luddy, Kimberly Chen, Lu Lee, Jae K. Harrison, Louis B. Czerniecki, Brian J. Soliman, Hatem Enderling, Heiko Breast Cancer Res Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13058-017-0870-1) contains supplementary material, which is available to authorized users. BioMed Central 2017-06-30 2017 /pmc/articles/PMC5493088/ /pubmed/28666457 http://dx.doi.org/10.1186/s13058-017-0870-1 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Poleszczuk, Jan Luddy, Kimberly Chen, Lu Lee, Jae K. Harrison, Louis B. Czerniecki, Brian J. Soliman, Hatem Enderling, Heiko Neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival |
title | Neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival |
title_full | Neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival |
title_fullStr | Neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival |
title_full_unstemmed | Neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival |
title_short | Neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival |
title_sort | neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493088/ https://www.ncbi.nlm.nih.gov/pubmed/28666457 http://dx.doi.org/10.1186/s13058-017-0870-1 |
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