Individualization of post-mastectomy radiotherapy and regional nodal irradiation based on treatment response after neoadjuvant chemotherapy for breast cancer : A systematic review

David Krug; René Baumann; Wilfried Budach; Jürgen Dunst; Petra Feyer; Rainer Fietkau; Wulf Haase; Wolfgang Harms; Thomas Hehr; Marc D Piroth; Felix Sedlmayer; Rainer Souchon; Frederik Wenz; Rolf Sauer

doi:10.1007/s00066-018-1270-x

Individualization of post-mastectomy radiotherapy and regional nodal irradiation based on treatment response after neoadjuvant chemotherapy for breast cancer : A systematic review

Strahlenther Onkol. 2018 Jul;194(7):607-618. doi: 10.1007/s00066-018-1270-x. Epub 2018 Jan 30.

Authors

David Krug^{1

2}, René Baumann³, Wilfried Budach⁴, Jürgen Dunst³, Petra Feyer⁵, Rainer Fietkau⁶, Wulf Haase⁷, Wolfgang Harms⁸, Thomas Hehr⁹, Marc D Piroth¹⁰, Felix Sedlmayer¹¹, Rainer Souchon¹², Frederik Wenz¹³, Rolf Sauer⁶

Affiliations

¹ Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. david.krug@med.uni-heidelberg.de.
² Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany. david.krug@med.uni-heidelberg.de.
³ University Hospital Schleswig-Holstein, Kiel, Germany.
⁴ Heinrich-Heine-University, Duesseldorf, Germany.
⁵ Vivantes Hospital Neukoelln, Berlin, Germany.
⁶ University Hospital Erlangen, Erlangen, Germany.
⁷ Formerly St.-Vincentius-Hospital, Karlsruhe, Germany.
⁸ St. Claraspital, Basel, Switzerland.
⁹ Department of Radiation Oncology, Marienhospital Stuttgart, Stuttgart, Germany.
¹⁰ HELIOS-Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany.
¹¹ Paracelsus Medical University Hospital, Salzburg, Austria.
¹² Formerly University Hospital Tuebingen, Tuebingen, Germany.
¹³ Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany.

PMID: 29383405
DOI: 10.1007/s00066-018-1270-x

Abstract

Purpose: To review the evidence regarding post-mastectomy radiotherapy (PMRT) and regional nodal irradiation (RNI) after neoadjuvant chemotherapy (NACT) for breast cancer, with a special focus on individualization of adjuvant radiotherapy based on treatment response.

Methods: A systematic literature search using the PubMed/Medline database was performed. We included prospective and retrospective reports with a minimum of 10 patients that had been published since 1^st January 2000, and provided clinical outcome data analyzed by treatment response and radiotherapy.

Results: Out of 763 articles identified via PubMed/Medline and hand search, 68 full text-articles were assessed for eligibility after screening of title and abstract. 13 studies were included in the systematic review, 9 for PMRT and 5 for RNI. All included studies were retrospective reports.

Conclusions: There is a considerable lack of evidence regarding the role of adjuvant radiotherapy and its individualization based on treatment response after NACT. Results of prospective randomized trials such as NSABP B‑51/RTOG 1304 and Alliance A11202 are eagerly awaited.

Keywords: Breast neoplasms; Local recurrence; Neoadjuvant therapy; Radiotherapy.

Publication types

Review
Systematic Review

MeSH terms

Breast Neoplasms / mortality
Breast Neoplasms / pathology
Breast Neoplasms / therapy*
Chemotherapy, Adjuvant*
Combined Modality Therapy
Female
Humans
Lymphatic Irradiation / methods*
Mastectomy*
Neoadjuvant Therapy*
Precision Medicine*
Radiotherapy, Adjuvant / methods*