A study conducted by members of the American College of Surgeons has identified a need for greater uniformity and guidelines regarding radiation therapy following neoadjuvant chemotherapy in patients with initial node-positive breast cancer.
Neoadjuvant chemotherapy is increasingly being used in the management of stage 2 breast cancer because it has led to improved overall survival in this patient population. However, it can also elicit a broad range of adverse responses, complicating the decision-making process for practitioners.
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In an article published in International Journal of Radiation Oncology, Biology, Physics, authors lead by Burce G Haffty, MD, Rutgers Cancer Institute of New Jersey (New Brunswick), examined the variability in radiation therapy decisions following neoadjuvant chemotherapy for 685 patients with breast cancer enrolled in the ACOSOG Z1071 trial.
A total of 401 of which had nodal metastasis at initial diagnosis, all of whom underwent surgery within 84 days of completion of neoadjuvant chemotherapy. Mastectomy was performed in 148 patients (36.9%), mastectomy with immediate reconstruction in 107 patients (26.7%), and breast-conserving surgery in 146 patients (36.4%). In the other 284 node-negative patients, 84 (29.6%) underwent mastectomy, 69 (24.3%) underwent mastectomy with immediate reconstruction, and 131 (46.1%) underwent breast-conserving surgery. The investigators found that bilateral mastectomy rates were higher in patients undergoing reconstruction than those not (66.5% vs 32.2%).
Use of internal mammary radiation therapy (range, 7.8–11.2%) and supraclavicular radiation therapy (range, 46–52.2%) did not differ between surgical approaches, although the latter was omitted in 47.3% of patients. Use of axillary radiation, however, was significantly more frequent in patients who were node-positive after neoadjuvant chemotherapy versus those who were node-negative, although 22% of node-negative patients received axillary radiation. Post-mastectomy radiation therapy was more often omitted after reconstruction than after mastectomy (23.9% vs 12.1%).
Together, the results revealed wide-ranging variability in field. The investigators concluded by calling for practice guidelines and greater education to bring greater uniformity to best practices for radiation therapy following neoadjuvant chemotherapy in patients with breast cancer.
