Concurrent chemo-radiotherapy following neoadjuvant chemotherapy in locally advanced breast cancer

<p>Abstract</p> <p>Background</p> <p>Despite broad advances in multimodal treatment of locally advanced breast cancer (LABC), 30 to 40% of patients develop loco-regional relapse. The aim of this study was to analyze in a retrospective manner the effectiveness of concurrent chemo-radiotherapy (CCRTh) after neoadjuvant chemotherapy (NCT) in patients with LABC.</p> <p>Methods</p> <p>One hundred twelve patients with LABC (stage IIB-IIIB) were treated with NCT (5-fluorouracil 500 mg/m², doxorubicin 50 mg/m², and cyclophosphamide 500 mg/m²(FAC), or doxorubicin 50 mg/m²and cyclophosphamide 500 mg/m²(AC) IV in four 21-day courses) followed by CCRTh (60 Gy breast irradiation and weekly mitomycin 5 mg/m², 5-fluorouracil 500 mg/m², and dexamethasone 16 mg, or cisplatin 30 mg/m², gemcitabine 100 mg/m²and dexamethasone 16 mg), and 6–8 weeks later, surgery and two additional courses of FAC, AC, or paclitaxel 90 mg/m²weekly for 12 weeks, and in case of estrogen-receptor positive patients, hormonal therapy.</p> <p>Results</p> <p>Stages IIB, IIIA and -B were 21.4, 42.9, and 35.7%, respectively. Pathological complete response (pCR) in the breast was 42% (95% CI, 33.2–50.5%) and, 29.5% (95% CI, 21.4–37.5%) if including both the breast and the axillary nodes. Multivariate analysis showed that the main determinant of pCR was negative estrogen-receptor status (HR = 3.8; 95% CI, 1.5–9; <it>p </it>= 0.016). The 5-year disease-free survival (DFS) was 76.9% (95% CI, 68.2–84.7%). No relationship between pCR and DFS was found. Multivariate analysis demonstrated that the main DFS determinant was clinical stage (IIB and IIIA <it>vs. </it>IIIB, HR = 3.1; 95% CI, 1.02–9.74; <it>p </it>= 0.04). Only one patient had local recurrence. Five-year overall survival was 84.2% (95% CI, 75–93.2%). The toxicity profile was acceptable.</p> <p>Conclusion</p> <p>This non-conventional multimodal treatment has good loco-regional control for LABC. Randomized clinical trials of preoperative CCRTh following chemotherapy, in patients with LABC are warranted.</p