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International Journal of Breast Cancer
Volume 2015, Article ID 147476, 7 pages
http://dx.doi.org/10.1155/2015/147476
Research Article

Locoregional Recurrence Risk in Breast Cancer Patients with Estrogen Receptor Positive Tumors and Residual Nodal Disease following Neoadjuvant Chemotherapy and Mastectomy without Radiation Therapy

1Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
2Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
3Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA 30322, USA
4Department of Pathology, Emory University, Atlanta, GA 30322, USA
5Department of Radiation Oncology, Stanford Medical Center, Stanford, CA 94305, USA
6Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA

Received 2 April 2015; Accepted 1 July 2015

Academic Editor: Ian S. Fentiman

Copyright © 2015 Shravan Kandula et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Among breast cancer patients treated with neoadjuvant chemotherapy (NAC) and mastectomy, locoregional recurrence (LRR) rates are unclear in women with ER+ tumors treated with adjuvant endocrine therapy without postmastectomy radiation (PMRT). To determine if PMRT is needed in these patients, we compared LRR rates of patients with ER+ tumors (treated with adjuvant endocrine therapy) with women who have non-ER+ tumors. 85 consecutive breast cancer patients (87 breast tumors) treated with NAC and mastectomy without PMRT were reviewed. Patients were divided by residual nodal disease (ypN) status (ypN+ versus ypN0) and then stratified by receptor subtype. Among ypN+ patients (), five-year LRR risk in patients with ER+, Her2+, and triple negative tumors was 5%, 33%, and 37%, respectively (). Among ypN+/ER+ patients, lymphovascular invasion and grade three disease increased the five-year LRR risk to 13% and 11%, respectively. Among ypN0 patients (), five-year LRR risk in patients with ER+, Her2+, and triple negative tumors was 7%, 22%, and 6%, respectively (). In women with ER+ tumors and residual nodal disease, endocrine therapy may be sufficient adjuvant treatment, except in patients with lymphovascular invasion or grade three tumors where PMRT may still be indicated.