The Curative Effect Of Radiotherapy In Breast Cancer Patients Who Are Down-staging After Neoadjuvant Chemotherapy And Modified Radical Mastectomy

Objective: To investigate retrospectively the effect of radiotherapy in breast cancer patients who are down-staging from T3-4 to T0-2?N2-3 to N0-1?N1 to N0 after neoadjuvant chemotherapy and modified radical mastectomy.Methods: Between January 2005 and december 2010,there were 103 cases who are down-staging from T3-4 to T0-2 ? N2-3 to N0-1 ? N1 to N0 after neoadjuvant chemotherapy and modified radical mastectomy in the Affiliated Tumor Hospital of Guangxi Medical University.The patients were divided into three groups according to the stages: T3-4 decreased into T0-2 group(n = 43),N2-3 decreased into N0-1 group(n = 33),and N1 decreased into N0 group(n =27).In addition,patients were divided into radiotherapy group(42 cases)and no radiotherapy group(n = 61).To evaluate the 5-year local recurrence-free survival rate(LRRFS),the 5 years distant metastasis-free survival rate(DDFS),the 5-year disease-free survival rate(DFS)and the 5-year overall survival rate(OS).In addition,we aimed to explore the risk factors for the prognosis of patients with breast cancer.Results: The median follow-up time was 93(30-132)months.In the T3-4downstaging into T0-2 group,radiotherapy can improve the 5 year LRRFS and DFS and the difference was statistically significant,while there were no significant differences in 5 years DDFS or OS.In the N2-3 downstaging into N1 group,radiotherapy can improve all of the survival rate of the patients and the difference was statistically significant.There was neither significant difference in the 5 year survival index of N2-3 downstaging into N1 nor N1 downstaging into N0 group.Multivariate analysis showed that postoperative radiotherapy(PMRT)was an independent prognostic factor of LRRFS and DFS in the T3-4downstaging into T0-2 group,The local recurrence and progression risks of patients with radiotherapy are significantly lower than that in patients without radiotherapy,but PMRT was not a prognostic factor of DDFS or OS.PMRT was an independent prognostic factor of LRRFS ?DDFS?DFS and OS in the N2-3downstaging into N1 group,The local recurrence?distant metastasis?progression and death risks of patients with radiotherapy are significantly lower than that in patients without radiotherapy,but PMRT was not a prognostic factor in the N1-3downstaging into N0 group.Conclusion: PMRT can improve the 5 year LRRFS?DFS of the patients who are down-staging from T3-4 to T0-2 after neoadjuvant chemotherapy and modified radical mastectomy,PMRT also can improve the 5 year survival rate of patients who are down-staging from N2-3 to N1.Radiotherapy has no significant effect on the 5 year survival index of patients who are down-staging from N1-3to N0,but Whether patients who are down-staging from N1-3 to N0 will undergo radiotherapy still needs further sample,multicenter,prospective studies.