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. 2015 Jul 30:4:386.
doi: 10.1186/s40064-015-1116-2. eCollection 2015.

Higher locoregional recurrence rate for triple-negative breast cancer following neoadjuvant chemotherapy, surgery and radiotherapy

Chi Zhang  1 , Shuang Wang  2 , Hayley P Israel  3 , Sherry X Yan  3 , David P Horowitz  1 , Seth Crockford  3 , Daniela Gidea-Addeo  1 , K S Clifford Chao  1 , Kevin Kalinsky  4 , Eileen P Connolly  1
Affiliations

Higher locoregional recurrence rate for triple-negative breast cancer following neoadjuvant chemotherapy, surgery and radiotherapy

Chi Zhang et al. Springerplus. .

Abstract

Background: Breast cancer subtype, determined by expression of estrogen/progesterone receptor (ER/PR) and human epidermal growth factor receptor (HER)-2, is predictive for prognosis. The importance of subtype to locoregional recurrence (LRR) following neoadjuvant chemotherapy (NAC) is unknown, particularly after adjuvant radiotherapy (RT).

Methods: We retrospectively identified 160-breast cancer patients registered at Columbia University Medical Center from 1999 to 2012 treated with NAC, surgery and adjuvant RT.

Results: Patients were grouped by receptor status: hormone receptor positive (HR+) [(ER or PR+)/HER2-; n = 75], HER2+ (n = 46), or triple-negative (TNBC) [ER (-) PR (-) HER2 (-); n = 36]. The median follow-up was 28 months. 92.0% received an anthracycline-taxane based NAC and 80.4% of HER2+ patients received trastuzumab. All underwent surgical resection followed by RT. 15.6% had a pathologic complete response (pCR): 26% of HER2+, 5% of HR+, and 25% of TN. The actuarial rate of DM was 13.8% for the entire cohort, with equivalent rates by subtypes in non-pCR patients. The overall rate of LRR was 8%. However, the LRR rate was significantly higher for TNBC patients (22.2%) than HER2+ (5.6%) (p = 0.025) or HR+ (3.0%) (p = 0.037) in non-pCR group. In the pCR group, two patients had recurrence; one LRR and one a DM, both had TNBC. All LRR occurred in or near the radiation field.

Conclusions: TNBC patients with < pCR to NAC have a significantly higher LRR rate as compared to other subtypes even with surgery and adjuvant RT. Our data support a need to further intensify local therapy in TNBC patients.

Keywords: Locoregional recurrence rate; Neoadjuvant chemotherapy; Radiation; Triple-negative breast cancer.

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Figures

Fig. 1
Fig. 1
Comparisons of survivals between subtypes in non-pCR patients. a Locoregional-recurrence-free survival (LRR-Free Survival). b Distant-metastasis-free survival (DM-Free Survival). c Progress-free survival. d Overall survival. P values shown here are from comparisons among all three subtypes.
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