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Biological Subtype Predicts Risk of Locoregional Recurrence After Mastectomy and Impact of Postmastectomy Radiation in a Large National Database.

Publication ,  Journal Article
Tseng, YD; Uno, H; Hughes, ME; Niland, JC; Wong, Y-N; Theriault, R; Blitzblau, RC; Moy, B; Breslin, T; Edge, SB; Hassett, MJ; Punglia, RS
Published in: Int J Radiat Oncol Biol Phys
November 1, 2015

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.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

November 1, 2015

Volume

93

Issue

3

Start / End Page

622 / 630

Location

United States

Related Subject Headings

  • Triple Negative Breast Neoplasms
  • Trastuzumab
  • Time Factors
  • Risk Assessment
  • Receptors, Progesterone
  • Receptors, Estrogen
  • Receptor, erbB-2
  • Receptor, ErbB-2
  • Propensity Score
  • Oncology & Carcinogenesis
 

Citation

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MLA
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Tseng, Y. D., Uno, H., Hughes, M. E., Niland, J. C., Wong, Y.-N., Theriault, R., … Punglia, R. S. (2015). Biological Subtype Predicts Risk of Locoregional Recurrence After Mastectomy and Impact of Postmastectomy Radiation in a Large National Database. Int J Radiat Oncol Biol Phys, 93(3), 622–630. https://doi.org/10.1016/j.ijrobp.2015.07.006
Tseng, Yolanda D., Hajime Uno, Melissa E. Hughes, Joyce C. Niland, Yu-Ning Wong, Richard Theriault, Rachel C. Blitzblau, et al. “Biological Subtype Predicts Risk of Locoregional Recurrence After Mastectomy and Impact of Postmastectomy Radiation in a Large National Database.Int J Radiat Oncol Biol Phys 93, no. 3 (November 1, 2015): 622–30. https://doi.org/10.1016/j.ijrobp.2015.07.006.
Tseng YD, Uno H, Hughes ME, Niland JC, Wong Y-N, Theriault R, et al. Biological Subtype Predicts Risk of Locoregional Recurrence After Mastectomy and Impact of Postmastectomy Radiation in a Large National Database. Int J Radiat Oncol Biol Phys. 2015 Nov 1;93(3):622–30.
Tseng, Yolanda D., et al. “Biological Subtype Predicts Risk of Locoregional Recurrence After Mastectomy and Impact of Postmastectomy Radiation in a Large National Database.Int J Radiat Oncol Biol Phys, vol. 93, no. 3, Nov. 2015, pp. 622–30. Pubmed, doi:10.1016/j.ijrobp.2015.07.006.
Tseng YD, Uno H, Hughes ME, Niland JC, Wong Y-N, Theriault R, Blitzblau RC, Moy B, Breslin T, Edge SB, Hassett MJ, Punglia RS. Biological Subtype Predicts Risk of Locoregional Recurrence After Mastectomy and Impact of Postmastectomy Radiation in a Large National Database. Int J Radiat Oncol Biol Phys. 2015 Nov 1;93(3):622–630.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

November 1, 2015

Volume

93

Issue

3

Start / End Page

622 / 630

Location

United States

Related Subject Headings

  • Triple Negative Breast Neoplasms
  • Trastuzumab
  • Time Factors
  • Risk Assessment
  • Receptors, Progesterone
  • Receptors, Estrogen
  • Receptor, erbB-2
  • Receptor, ErbB-2
  • Propensity Score
  • Oncology & Carcinogenesis