ASTRO 2023: Can Neoadjuvant CRT Improve Outcomes in Locally Advanced Breast Cancer?

By: Joshua D. Madera, MD
Posted: Friday, October 20, 2023

For patients with inoperable locally advanced breast cancer, the use of neoadjuvant concurrent chemoradiation therapy (CRT) may improve operability, survival rates, and rates of pathologic complete response, according to a presentation given at the 2023 American Society for Radiology Oncology (ASTRO) Annual Meeting (Abstract 103). Additional investigative efforts are needed to better optimize management for this patient population, explained Priya Iyer, MD, RT, MBBS, of the Cancer Institute, Chennai, India, and colleagues.

From 2017 to 2021, 202 female patients with stage III locally advanced breast cancer were recruited for the study. Patients were stratified based on disease stage as stage IIIA (23.7%), stage IIIB (65.3%), or stage IIIC (10.8%). They were further characterized based on hormone receptor status. All patients were administered neoadjuvant chemotherapy with doxorubicin, cyclophosphamide, and paclitaxel. Concurrent radiotherapy was administered to the involved breast, axilla, supraclavicular fossa, and internal mammary chain. Following the completion of neoadjuvant chemotherapy, patients were assessed to determine the appropriate surgical intervention based on their extent of disease and hormone receptor status.

The study findings revealed that after completing neoadjuvant chemotherapy, 88.1% of patients underwent a modified radical mastectomy, 8.5% had inoperable disease, and 3.4% declined surgery because they achieved a clinical complete response to treatment. Of the patients who had a modified radical mastectomy, 32.2% achieved a pathologic complete response. Moreover, treatment-related adverse events included grade 3 skin reactions (19.3%) and postoperative wound morbidity requiring hospitalization (10.6%). Furthermore, in this population cohort, the overall survival and event-free survival rates were 71.5% and 63.8%.

Disclosure: Dr. Iyer reported no conflicts of interest.

2023 ASTRO Annual Meeting