Locally advanced breast cancer treated with neoadjuvant chemotherapy and adjuvant radiotherapy: A retrospective cohort analysis

Jonathan H. Klein, William Tran, Elyse Watkins, Danny Vesprini, Frances C. Wright, Nicole J. Look Hong, Sonal Ghandi, Alex Kiss, Gregory J. Czarnota

Research output: Contribution to journalArticle

Abstract

Background: Neoadjuvant chemotherapy (NAC) is increasingly used to treat locally advanced breast cancer (LABC). Improved response to NAC correlates with better survival outcomes. The dual purpose of this study is to report recurrence and survival outcomes for LABC patients treated with NAC, surgery and adjuvant radiotherapy and to correlate these outcomes with tumour response after NAC using multiple response assessment methods. Methods: All LABC patients treated for curative intent with NAC, surgery, and adjuvant radiotherapy at our institute between January 2009 and December 2014 were included for analysis. NAC was mostly anthracycline and taxane-based; radiotherapy consisted of 50 Gy to the breast/chest wall and regional lymph nodes. Response to NAC was categorized using synoptic pathology reports, modified-RECIST and Chevallier scores. Survival curves were generated by the Kaplan-Meier method and compared using the log-rank test. Results: The cohort included 103 patients nearly equally divided between Stage II (n = 53) and Stage III (n = 50). Rates of locoregional control (LRC), recurrence-free survival (RFS), and overall survival (OS) were 99, 98, and 100% at 1 year and 89, 69 and 77% at 5 years, respectively. Responses to NAC did not correlate with LRC (p > 0.05) but did correlate with RFS and OS (p < 0.05), except that the Chevallier score did not predict RFS (p = 0.06). Using bivariate Cox modeling tumour size before (p = 0.003) and after (p < 0.001) NAC, stage group (p = 0.05), and response assessed by synoptic pathology (p = 0.05), modified-RECIST (p = 0.001), and Chevallier score (p = 0.015) all predicted for RFS. No factors predicted for LRC. Conclusion: Pathologic response by all tested methods correlated with improved survival but were not associated with decreased LRC.

Original languageEnglish (US)
Article number306
JournalBMC Cancer
Volume19
Issue number1
DOIs
StatePublished - Apr 3 2019
Externally publishedYes

Fingerprint

Adjuvant Radiotherapy
Cohort Studies
Breast Neoplasms
Drug Therapy
Survival
Recurrence
Pathology
Anthracyclines
Thoracic Wall
Neoplasms
Breast
Radiotherapy
Lymph Nodes

Keywords

  • Breast cancer
  • Chevallier
  • Neoadjuvant therapy
  • Pathologic response
  • Radiotherapy
  • Response

ASJC Scopus subject areas

  • Oncology
  • Genetics
  • Cancer Research

Cite this

Locally advanced breast cancer treated with neoadjuvant chemotherapy and adjuvant radiotherapy : A retrospective cohort analysis. / Klein, Jonathan H.; Tran, William; Watkins, Elyse; Vesprini, Danny; Wright, Frances C.; Look Hong, Nicole J.; Ghandi, Sonal; Kiss, Alex; Czarnota, Gregory J.

In: BMC Cancer, Vol. 19, No. 1, 306, 03.04.2019.

Research output: Contribution to journalArticle

Klein, JH, Tran, W, Watkins, E, Vesprini, D, Wright, FC, Look Hong, NJ, Ghandi, S, Kiss, A & Czarnota, GJ 2019, 'Locally advanced breast cancer treated with neoadjuvant chemotherapy and adjuvant radiotherapy: A retrospective cohort analysis', BMC Cancer, vol. 19, no. 1, 306. https://doi.org/10.1186/s12885-019-5499-2
Klein, Jonathan H. ; Tran, William ; Watkins, Elyse ; Vesprini, Danny ; Wright, Frances C. ; Look Hong, Nicole J. ; Ghandi, Sonal ; Kiss, Alex ; Czarnota, Gregory J. / Locally advanced breast cancer treated with neoadjuvant chemotherapy and adjuvant radiotherapy : A retrospective cohort analysis. In: BMC Cancer. 2019 ; Vol. 19, No. 1.
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abstract = "Background: Neoadjuvant chemotherapy (NAC) is increasingly used to treat locally advanced breast cancer (LABC). Improved response to NAC correlates with better survival outcomes. The dual purpose of this study is to report recurrence and survival outcomes for LABC patients treated with NAC, surgery and adjuvant radiotherapy and to correlate these outcomes with tumour response after NAC using multiple response assessment methods. Methods: All LABC patients treated for curative intent with NAC, surgery, and adjuvant radiotherapy at our institute between January 2009 and December 2014 were included for analysis. NAC was mostly anthracycline and taxane-based; radiotherapy consisted of 50 Gy to the breast/chest wall and regional lymph nodes. Response to NAC was categorized using synoptic pathology reports, modified-RECIST and Chevallier scores. Survival curves were generated by the Kaplan-Meier method and compared using the log-rank test. Results: The cohort included 103 patients nearly equally divided between Stage II (n = 53) and Stage III (n = 50). Rates of locoregional control (LRC), recurrence-free survival (RFS), and overall survival (OS) were 99, 98, and 100{\%} at 1 year and 89, 69 and 77{\%} at 5 years, respectively. Responses to NAC did not correlate with LRC (p > 0.05) but did correlate with RFS and OS (p < 0.05), except that the Chevallier score did not predict RFS (p = 0.06). Using bivariate Cox modeling tumour size before (p = 0.003) and after (p < 0.001) NAC, stage group (p = 0.05), and response assessed by synoptic pathology (p = 0.05), modified-RECIST (p = 0.001), and Chevallier score (p = 0.015) all predicted for RFS. No factors predicted for LRC. Conclusion: Pathologic response by all tested methods correlated with improved survival but were not associated with decreased LRC.",
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T2 - A retrospective cohort analysis

AU - Klein, Jonathan H.

AU - Tran, William

AU - Watkins, Elyse

AU - Vesprini, Danny

AU - Wright, Frances C.

AU - Look Hong, Nicole J.

AU - Ghandi, Sonal

AU - Kiss, Alex

AU - Czarnota, Gregory J.

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N2 - Background: Neoadjuvant chemotherapy (NAC) is increasingly used to treat locally advanced breast cancer (LABC). Improved response to NAC correlates with better survival outcomes. The dual purpose of this study is to report recurrence and survival outcomes for LABC patients treated with NAC, surgery and adjuvant radiotherapy and to correlate these outcomes with tumour response after NAC using multiple response assessment methods. Methods: All LABC patients treated for curative intent with NAC, surgery, and adjuvant radiotherapy at our institute between January 2009 and December 2014 were included for analysis. NAC was mostly anthracycline and taxane-based; radiotherapy consisted of 50 Gy to the breast/chest wall and regional lymph nodes. Response to NAC was categorized using synoptic pathology reports, modified-RECIST and Chevallier scores. Survival curves were generated by the Kaplan-Meier method and compared using the log-rank test. Results: The cohort included 103 patients nearly equally divided between Stage II (n = 53) and Stage III (n = 50). Rates of locoregional control (LRC), recurrence-free survival (RFS), and overall survival (OS) were 99, 98, and 100% at 1 year and 89, 69 and 77% at 5 years, respectively. Responses to NAC did not correlate with LRC (p > 0.05) but did correlate with RFS and OS (p < 0.05), except that the Chevallier score did not predict RFS (p = 0.06). Using bivariate Cox modeling tumour size before (p = 0.003) and after (p < 0.001) NAC, stage group (p = 0.05), and response assessed by synoptic pathology (p = 0.05), modified-RECIST (p = 0.001), and Chevallier score (p = 0.015) all predicted for RFS. No factors predicted for LRC. Conclusion: Pathologic response by all tested methods correlated with improved survival but were not associated with decreased LRC.

AB - Background: Neoadjuvant chemotherapy (NAC) is increasingly used to treat locally advanced breast cancer (LABC). Improved response to NAC correlates with better survival outcomes. The dual purpose of this study is to report recurrence and survival outcomes for LABC patients treated with NAC, surgery and adjuvant radiotherapy and to correlate these outcomes with tumour response after NAC using multiple response assessment methods. Methods: All LABC patients treated for curative intent with NAC, surgery, and adjuvant radiotherapy at our institute between January 2009 and December 2014 were included for analysis. NAC was mostly anthracycline and taxane-based; radiotherapy consisted of 50 Gy to the breast/chest wall and regional lymph nodes. Response to NAC was categorized using synoptic pathology reports, modified-RECIST and Chevallier scores. Survival curves were generated by the Kaplan-Meier method and compared using the log-rank test. Results: The cohort included 103 patients nearly equally divided between Stage II (n = 53) and Stage III (n = 50). Rates of locoregional control (LRC), recurrence-free survival (RFS), and overall survival (OS) were 99, 98, and 100% at 1 year and 89, 69 and 77% at 5 years, respectively. Responses to NAC did not correlate with LRC (p > 0.05) but did correlate with RFS and OS (p < 0.05), except that the Chevallier score did not predict RFS (p = 0.06). Using bivariate Cox modeling tumour size before (p = 0.003) and after (p < 0.001) NAC, stage group (p = 0.05), and response assessed by synoptic pathology (p = 0.05), modified-RECIST (p = 0.001), and Chevallier score (p = 0.015) all predicted for RFS. No factors predicted for LRC. Conclusion: Pathologic response by all tested methods correlated with improved survival but were not associated with decreased LRC.

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KW - Chevallier

KW - Neoadjuvant therapy

KW - Pathologic response

KW - Radiotherapy

KW - Response

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