Predictors of locoregional recurrence after neoadjuvant chemotherapy

Results from combined analysis of national surgical adjuvant breast and bowel project B-18 and B-27

Eleftherios P. Mamounas, Stewart J. Anderson, James J. Dignam, Harry D. Bear, Thomas B. Julian, Charles E. Geyer, Alphonse Taghian, D. Lawrence Wickerham, Norman Wolmark

Research output: Contribution to journalArticle

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Abstract

Purpose: The limited information on predictors of locoregional recurrence (LRR) after neoadjuvant chemotherapy (NC) has resulted in controversy about the optimal use of adjuvant radiotherapy and the timing of sentinel lymph node biopsy. Patients and Methods: We examined patterns and predictors of LRR as first event in combined analysis of two National Surgical Adjuvant Breast and Bowel Project (NSABP) neoadjuvant trials. NC was either doxorubicin/ cyclophosphamide (AC) alone or AC followed by neoadjuvant/adjuvant docetaxel. Lumpectomy patients received breast radiotherapy alone; mastectomy patients received no radiotherapy. Pathologic complete response was defined as the absence of invasive tumor in the breast. Multivariate analyses were used to identify independent predictors of LRR. The primary end point was time to LRR as first event. Results: In 3,088 patients, 335 LRR events had occurred after 10 years of follow-up. The 10-year cumulative incidence of LRR was 12.3% for mastectomy patients (8.9% local; 3.4% regional) and 10.3% for lumpectomy plus breast radiotherapy patients (8.1% local; 2.2% regional). Independent predictors of LRR in lumpectomy patients were age, clinical nodal status (before NC), and pathologic nodal status/breast tumor response; in mastectomy patients, they were clinical tumor size (before NC), clinical nodal status (before NC), and pathologic nodal status/breast tumor response. By using these independent predictors, groups at low, intermediate, and high risk of LRR could be identified. Nomograms that incorporate these independent predictors were created. Conclusion: In patients treated with NC, age, clinical tumor characteristics before NC, and pathologic nodal status/breast tumor response after NC can be used to predict risk for LRR and to optimize the use of adjuvant radiotherapy.

Original languageEnglish (US)
Pages (from-to)3960-3966
Number of pages7
JournalJournal of Clinical Oncology
Volume30
Issue number32
DOIs
StatePublished - Nov 10 2012

Fingerprint

Breast
Recurrence
Drug Therapy
Segmental Mastectomy
Mastectomy
Breast Neoplasms
Adjuvant Radiotherapy
Radiotherapy
docetaxel
Sentinel Lymph Node Biopsy
Nomograms
Doxorubicin
Cyclophosphamide
Neoplasms
Multivariate Analysis
Incidence

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Predictors of locoregional recurrence after neoadjuvant chemotherapy : Results from combined analysis of national surgical adjuvant breast and bowel project B-18 and B-27. / Mamounas, Eleftherios P.; Anderson, Stewart J.; Dignam, James J.; Bear, Harry D.; Julian, Thomas B.; Geyer, Charles E.; Taghian, Alphonse; Wickerham, D. Lawrence; Wolmark, Norman.

In: Journal of Clinical Oncology, Vol. 30, No. 32, 10.11.2012, p. 3960-3966.

Research output: Contribution to journalArticle

Mamounas, Eleftherios P. ; Anderson, Stewart J. ; Dignam, James J. ; Bear, Harry D. ; Julian, Thomas B. ; Geyer, Charles E. ; Taghian, Alphonse ; Wickerham, D. Lawrence ; Wolmark, Norman. / Predictors of locoregional recurrence after neoadjuvant chemotherapy : Results from combined analysis of national surgical adjuvant breast and bowel project B-18 and B-27. In: Journal of Clinical Oncology. 2012 ; Vol. 30, No. 32. pp. 3960-3966.
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abstract = "Purpose: The limited information on predictors of locoregional recurrence (LRR) after neoadjuvant chemotherapy (NC) has resulted in controversy about the optimal use of adjuvant radiotherapy and the timing of sentinel lymph node biopsy. Patients and Methods: We examined patterns and predictors of LRR as first event in combined analysis of two National Surgical Adjuvant Breast and Bowel Project (NSABP) neoadjuvant trials. NC was either doxorubicin/ cyclophosphamide (AC) alone or AC followed by neoadjuvant/adjuvant docetaxel. Lumpectomy patients received breast radiotherapy alone; mastectomy patients received no radiotherapy. Pathologic complete response was defined as the absence of invasive tumor in the breast. Multivariate analyses were used to identify independent predictors of LRR. The primary end point was time to LRR as first event. Results: In 3,088 patients, 335 LRR events had occurred after 10 years of follow-up. The 10-year cumulative incidence of LRR was 12.3{\%} for mastectomy patients (8.9{\%} local; 3.4{\%} regional) and 10.3{\%} for lumpectomy plus breast radiotherapy patients (8.1{\%} local; 2.2{\%} regional). Independent predictors of LRR in lumpectomy patients were age, clinical nodal status (before NC), and pathologic nodal status/breast tumor response; in mastectomy patients, they were clinical tumor size (before NC), clinical nodal status (before NC), and pathologic nodal status/breast tumor response. By using these independent predictors, groups at low, intermediate, and high risk of LRR could be identified. Nomograms that incorporate these independent predictors were created. Conclusion: In patients treated with NC, age, clinical tumor characteristics before NC, and pathologic nodal status/breast tumor response after NC can be used to predict risk for LRR and to optimize the use of adjuvant radiotherapy.",
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T1 - Predictors of locoregional recurrence after neoadjuvant chemotherapy

T2 - Results from combined analysis of national surgical adjuvant breast and bowel project B-18 and B-27

AU - Mamounas, Eleftherios P.

AU - Anderson, Stewart J.

AU - Dignam, James J.

AU - Bear, Harry D.

AU - Julian, Thomas B.

AU - Geyer, Charles E.

AU - Taghian, Alphonse

AU - Wickerham, D. Lawrence

AU - Wolmark, Norman

PY - 2012/11/10

Y1 - 2012/11/10

N2 - Purpose: The limited information on predictors of locoregional recurrence (LRR) after neoadjuvant chemotherapy (NC) has resulted in controversy about the optimal use of adjuvant radiotherapy and the timing of sentinel lymph node biopsy. Patients and Methods: We examined patterns and predictors of LRR as first event in combined analysis of two National Surgical Adjuvant Breast and Bowel Project (NSABP) neoadjuvant trials. NC was either doxorubicin/ cyclophosphamide (AC) alone or AC followed by neoadjuvant/adjuvant docetaxel. Lumpectomy patients received breast radiotherapy alone; mastectomy patients received no radiotherapy. Pathologic complete response was defined as the absence of invasive tumor in the breast. Multivariate analyses were used to identify independent predictors of LRR. The primary end point was time to LRR as first event. Results: In 3,088 patients, 335 LRR events had occurred after 10 years of follow-up. The 10-year cumulative incidence of LRR was 12.3% for mastectomy patients (8.9% local; 3.4% regional) and 10.3% for lumpectomy plus breast radiotherapy patients (8.1% local; 2.2% regional). Independent predictors of LRR in lumpectomy patients were age, clinical nodal status (before NC), and pathologic nodal status/breast tumor response; in mastectomy patients, they were clinical tumor size (before NC), clinical nodal status (before NC), and pathologic nodal status/breast tumor response. By using these independent predictors, groups at low, intermediate, and high risk of LRR could be identified. Nomograms that incorporate these independent predictors were created. Conclusion: In patients treated with NC, age, clinical tumor characteristics before NC, and pathologic nodal status/breast tumor response after NC can be used to predict risk for LRR and to optimize the use of adjuvant radiotherapy.

AB - Purpose: The limited information on predictors of locoregional recurrence (LRR) after neoadjuvant chemotherapy (NC) has resulted in controversy about the optimal use of adjuvant radiotherapy and the timing of sentinel lymph node biopsy. Patients and Methods: We examined patterns and predictors of LRR as first event in combined analysis of two National Surgical Adjuvant Breast and Bowel Project (NSABP) neoadjuvant trials. NC was either doxorubicin/ cyclophosphamide (AC) alone or AC followed by neoadjuvant/adjuvant docetaxel. Lumpectomy patients received breast radiotherapy alone; mastectomy patients received no radiotherapy. Pathologic complete response was defined as the absence of invasive tumor in the breast. Multivariate analyses were used to identify independent predictors of LRR. The primary end point was time to LRR as first event. Results: In 3,088 patients, 335 LRR events had occurred after 10 years of follow-up. The 10-year cumulative incidence of LRR was 12.3% for mastectomy patients (8.9% local; 3.4% regional) and 10.3% for lumpectomy plus breast radiotherapy patients (8.1% local; 2.2% regional). Independent predictors of LRR in lumpectomy patients were age, clinical nodal status (before NC), and pathologic nodal status/breast tumor response; in mastectomy patients, they were clinical tumor size (before NC), clinical nodal status (before NC), and pathologic nodal status/breast tumor response. By using these independent predictors, groups at low, intermediate, and high risk of LRR could be identified. Nomograms that incorporate these independent predictors were created. Conclusion: In patients treated with NC, age, clinical tumor characteristics before NC, and pathologic nodal status/breast tumor response after NC can be used to predict risk for LRR and to optimize the use of adjuvant radiotherapy.

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