Is there a role for salvage radiotherapy in locally advanced breast cancer refractory to neoadjuvant chemotherapy?

• Published in: Breast (Edinburgh) Vol. 31; pp. 192 - 196
• Main Authors: Coelho, R.C, Da Silva, F.M.L, Do Carmo, I.M.L, Bonaccorsi, B.V, Hahn, S.M, Faroni, L.D
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2017
• Subjects: Adult; Aged; Anthracyclines - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - therapy; Bridged-Ring Compounds - administration & dosage; Carcinoma, Ductal, Breast - radiotherapy; Carcinoma, Ductal, Breast - secondary; Carcinoma, Ductal, Breast - therapy; Carcinoma, Lobular - radiotherapy; Carcinoma, Lobular - secondary; Carcinoma, Lobular - therapy; Chemotherapy, Adjuvant; Disease-Free Survival; Dose Fractionation; Female; Hematology, Oncology and Palliative Medicine; Humans; Locally advanced; Mastectomy; Middle Aged; Neoadjuvant chemotherapy; Neoadjuvant Therapy; Neoplasm Staging; Radiotherapy; Retrospective Studies; Retrospective study; Salvage Therapy; Survival Rate; Taxoids - administration & dosage; Tumor Burden; Young Adult; Neoadjuvant chemotherapy; Breast cancer; Retrospective study; Radiotherapy; Locally advanced
• ISSN: 0960-9776; 1532-3080
• DOI: 10.1016/j.breast.2016.10.026

Abstract Introduction Locally advanced breast cancer (LABC) is a major problem, especially in developing countries. The standard treatment for LABC is neoadjuvant chemotherapy, with or without anti-Her2 therapy, followed by surgery, radiotherapy, and adjuvant systemic treatment if appropriate. However, there are few data in the literature addressing alternatives when neoadjuvant chemotherapy fails to reduce the tumour for surgery. Materials and methods We conducted a retrospective study including all patients who had non-metastatic LABC treated with neoadjuvant chemotherapy and who were not eligible for surgical resection; these patients were submitted to salvage radiotherapy (RTX) between January 2000 and December 2012 at the Brazilian National Cancer Institute. Results Fifty-seven patients were included, with a median age of 51 (23–72) years. The most frequent clinical stages were IIIA and IIIB, corresponding to 19.3% and 70.2%, respectively; mean tumour size was 8.74 (3–18) cm, and 44 patients (77.2%) had nodal involvement. Chemotherapeutic regimens containing anthracyclines were prescribed to 98.2% of the patients. Fifteen patients (26.3%) received taxanes and anthracyclines. Radiation dose was 50 Gy divided into 25 fractions; 43 patients (75.4%) had their tumours downsized by RTX and underwent mastectomy. Overall survival (OS) was 38 (23–52) months. Patients who were submitted to surgery had an OS of 49 (28–70) months and those who were not eligible for mastectomy after radiotherapy had an OS of 18 (9–27) months. Conclusion This retrospective study confirms that RTX is an effective treatment to downsize LABC tumours with low or no response to chemotherapy, thereby enabling surgical resection which may improve overall patient outcome.