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Evaluating Regional Nodal Irradiation Allocation and Association with Oncologic Outcomes in NSABP B-18, B-27, B-40, and B-41.
Mailhot Vega, Raymond B; Wang, Shu; Brooks, Eric D; Oladeru, Oluwadamilola T; Lockney, Natalie A; Spiguel, Lisa E; MacDonald, Shannon M; Mamounas, Eleftherios P; Mendenhall, Nancy P; Okunieff, Paul G; Lee, Ji-Hyun; Bradley, Julie A.
Afiliación
  • Mailhot Vega RB; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, Florida. Electronic address: rbmailhot@floridaproton.org.
  • Wang S; Department of Biostatistics, University of Florida College of Public Health and Health Professions & College of Medicine, Gainesville, Florida.
  • Brooks ED; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, Florida.
  • Oladeru OT; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, Florida.
  • Lockney NA; Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Spiguel LE; Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.
  • MacDonald SM; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts.
  • Mamounas EP; Department of General Surgery, Orlando Health, Orlando, Florida.
  • Mendenhall NP; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, Florida.
  • Okunieff PG; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, Florida.
  • Lee JH; Department of Biostatistics, University of Florida College of Public Health and Health Professions & College of Medicine, Gainesville, Florida.
  • Bradley JA; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, Florida.
Int J Radiat Oncol Biol Phys ; 113(3): 542-551, 2022 07 01.
Article en En | MEDLINE | ID: mdl-35418342
PURPOSE: There is a lack of level I evidence to guide radiation therapy recommendations for patients receiving neoadjuvant chemotherapy for breast cancer. We used 4 neoadjuvant chemotherapy trials to determine which patients benefit from regional nodal irradiation (RNI). METHODS AND MATERIALS: We obtained data from the NSABP (National Surgical Adjuvant Breast and Bowel Project) B-18, B-27, B-40, and B-41 clinical trials. B-40 and B-41 allowed RNI at physician's discretion. We evaluated locoregional recurrence (LRR), distant recurrence, disease-free survival, and overall survival (OS). Kaplan-Meier, Peto-Peto, χ2, Fisher exact, and Wilcoxon rank-sum tests were used for survival estimates and comparison. RESULTS: Median follow-up for B-18, B-27, B-40, and B-41 was 13.7, 9.7, 4.5, and 5.1 years, respectively, including 742, 2254, 1154, and 504 patients for analysis. On multivariable analysis, factors significantly associated with RNI included tumor size, ypN status, and tumor subtype; Hispanic patients were less likely to receive RNI. Patients with ypN+HER2+ disease who received RNI had improved OS. B-40 patients with ypN+HR+ disease had improved LRR. On multivariable analysis for the B-40 and B-41 study population, RNI was not associated with significantly improved OS, disease-free survival, distant recurrence, or LRR. CONCLUSIONS: RNI was associated with a clinical benefit for patients with ypN+HER2+ and ypN+HR+ disease. RNI was not significantly associated with a clinically beneficial outcome for the entire cohort. Prospective phase 3 clinical trials are needed to establish guidelines for patients who should receive RNI after neoadjuvant treatment, and action is necessary to eliminate the disparity in care delivery shown for Hispanic women.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Mama / Recurrencia Local de Neoplasia Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Female / Humans Idioma: En Revista: Int J Radiat Oncol Biol Phys Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Mama / Recurrencia Local de Neoplasia Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Female / Humans Idioma: En Revista: Int J Radiat Oncol Biol Phys Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos