Biological Subtype Predicts Risk of Locoregional Recurrence after Mastectomy and Impact of Postmastectomy Radiation in a Large National Database Presented in part at the 56th Annual Meeting of the American Society for Radiation Oncology, San Francisco, CA, September 14-17, 2014.

Yolanda D. Tseng*, Hajime Uno, Melissa E. Hughes, Joyce C. Niland, Yu Ning Wong, Richard Theriault, Rachel C. Blitzblau, Beverly Moy, Tara M Breslin, Stephen B. Edge, Michael J. Hassett, Rinaa S. Punglia

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

56 Scopus citations

Abstract

Purpose To evaluate locoregional recurrence (LRR) after mastectomy and impact of postmastectomy radiation (PMRT) by breast cancer subtype. Methods and Materials Between 2000 and 2009, 5673 patients with stage I to III breast carcinoma underwent mastectomy and nodal evaluation; 30% received PMRT. Isolated LRR (iLRR) and LRR were compared across groups defined by biological subtype and receipt of trastuzumab: luminal A (estrogen [ER]/progesterone [PR]+, HER2-, low/intermediate grade), luminal B (ER/PR+, HER2-, high grade), HER2 with trastuzumab, HER2 without trastuzumab, and triple negative (TN; ER-, PR-, HER2-). LRR hazard ratios (HR) were estimated with multivariable Fine and Gray models. The effect of PMRT on LRR was evaluated with Fine and Gray models stratified by propensity for PMRT. Results With a median follow-up time of 50.1 months, there were 19 iLRR and 109 LRR events. HER2 patients with trastuzumab had no iLRR and only a single LRR. Compared with luminal A patients, TN patients had significantly greater adjusted risk of iLRR (HR 14.10; 95% CI 2.97%-66.90%), with a similar trend among luminal B (HR 4.94; 95% CI 0.94%-25.82%) and HER2 patients without trastuzumab (HR 4.41; 95% CI 0.61%-32.11%). Although PMRT reduced LRR, the effect of PMRT varied by subgroup, with the greatest and smallest effects seen among luminal A (HR 0.17; 95% CI 0.05%-0.62%) and TN patients (HR 0.59; 95% CI 0.25%-1.35%), respectively. Conclusions TN patients had the highest risk of LRR and the least benefit from PMRT; these patients may benefit from alternative treatment strategies. In contrast, in the era of HER2-directed therapy, the role of local therapy may need to be reassessed among HER2 patients.

Original languageEnglish (US)
Pages (from-to)622-630
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume93
Issue number3
DOIs
StatePublished - Nov 1 2015

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Fingerprint

Dive into the research topics of 'Biological Subtype Predicts Risk of Locoregional Recurrence after Mastectomy and Impact of Postmastectomy Radiation in a Large National Database Presented in part at the 56th Annual Meeting of the American Society for Radiation Oncology, San Francisco, CA, September 14-17, 2014.'. Together they form a unique fingerprint.

Cite this