Research advances of postmastectomy radiotherapy in patients with T1–2N1M0 breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PU Hongyu ,  GAO Yanchun , HOU Lingmi

Department of Thyroid and Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

GAO Yanchun, Email: boyang11111@163.com

Keywords：

breast cancer; postmastectomy radiotherapy; neoadjuvant chemotherapy; positive axillary lymph node; prognosis

DOI：

10.7507/1007-9424.202204061

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To understand the progress of postmastectomy radiotherapy (PMRT) in patients with T1–2N1M0 breast cancer. Method The studies and the treatment guidelines relevant to PMRT in the patients with T1–2N1M0 breast cancer in recent years were analyzed and summarized. Results The ability of PMRT to improve the prognosis of patients with T1–2N1M0 breast cancer remained controversial. Owing to the patients with T1–2N1M0 breast cancer were heterogeneous, and the indications for PMRT had not been standardized. With the increasing use of neoadjuvant chemotherapy for early-stage breast cancer, some studies had attempted to formulate decisions about PMRT based on changes in tumor characteristics before and after neoadjuvant chemotherapy, but the findings were currently controversial. Conclusions Whether PMRT can improve prognosis and decision-making for patients with T1–2N1M0 breast cancer is still controversial. Some ongoing clinical trials may provide some references for the optimal decision-making of PMRT for patients with T1–2N1M0 breast cancer.

Citation： PU Hongyu, GAO Yanchun, HOU Lingmi. Research advances of postmastectomy radiotherapy in patients with T1–2N1M0 breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(10): 1395-1400. doi: 10.7507/1007-9424.202204061 Copy

1.	EBCTCG (Early Breast Cancer Trialists’ Collaborative Group), McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8 135 women in 22 randomised trials. Lancet, 2014, 383(9935): 2127-2135.
2.	Chagpar AB. Debate: postmastectomy radiation therapy in T1/2N1 disease. Ann Surg Oncol, 2021, 28(10): 5456-5460.
3.	Recht A, Comen EA, Fine RE, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update. J Clin Oncol, 2016, 34(36): 4431-4442.
4.	Curigliano G, Burstein HJ, Winer EP, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol, 2017, 28(8): 1700-1712.
5.	Senkus E, Kyriakides S, Ohno S, et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2015, 26 Suppl 5: v8-v30. doi: 10.1093/annonc/mdv298.
6.	Frasier LL, Holden S, Holden T, et al. Temporal trends in postmastectomy radiation therapy and breast reconstruction associated with changes in National Comprehensive Cancer Network Guidelines. JAMA Oncol, 2016, 2(1): 95-101.
7.	Abdel-Rahman O. Impact of postmastectomy radiotherapy on the outcomes of breast cancer patients with T1–2 N1 disease: an individual patient data analysis of three clinical trials. Strahlenther Onkol, 2019, 195(4): 297-305.
8.	Wu SP, Tam M, Shaikh F, et al. Post-mastectomy radiation therapy in breast cancer patients with nodal micrometastases. Ann Surg Oncol, 2018, 25(9): 2620-2631.
9.	Ohri N, Haffty BG. Is there a role for postmastectomy radiation (PMRT) in patients with T1–2 tumors and one to three positive lymph nodes treated in the modern era? Ann Surg Oncol, 2018, 25(7): 1788-1790.
10.	Asaga S, Kinoshita T, Shiino S, et al. Prognostic factors for breast cancer patients with T1–2 tumor and 1–3 positive axillary nodes treated using total mastectomy without radiotherapy. Breast J, 2019, 25(1): 26-33.
11.	McBride A, Allen P, Woodward W, et al. Locoregional recurrence risk for patients with T1, 2 breast cancer with 1–3 positive lymph nodes treated with mastectomy and systemic treatment. Int J Radiat Oncol Biol Phys, 2014, 89(2): 392-398.
12.	Kayali M, Abi Jaoude J, Tfayli A, et al. Post-mastectomy radiation therapy in breast cancer patients with 1–3 positive lymph nodes: no one size fits all. Crit Rev Oncol Hematol, 2020, 147: 102880. doi: 10.1016/j.critrevonc.2020.102880.
13.	Kaššák F, Rossier C, Picardi C, et al. Postmastectomy radiotherapy in T1–2 patients with one to three positive lymph nodes—Past, present and future. Breast, 2019, 48: 73-81.
14.	Xu FF, Cao L, Xu C, et al. Practical model to optimize the strategy of adjuvant postmastectomy radiotherapy in T1–2N1 breast cancer with modern systemic therapy. Front Oncol, 2022, 12: 789198. doi: 10.3389/fonc.2022.789198.
15.	Wang X, Zhang L, Zhang X, et al. Impact of clinical-pathological factors on locoregional recurrence in mastectomy patients with T1–2N1 breast cancer: who can omit adjuvant radiotherapy? Breast Cancer Res Treat, 2021, 190(2): 277-286.
16.	Vohra LM, Soomro R, Jabeen D, et al. Utility of post mastectomy radiotherapy among patients with T1/ T2 N1 disease: a retrospective cohort study. Ann Med Surg (Lond), 2021, 65: 102295. doi: 10.1016/j.amsu.2021.102295.
17.	Zhao JM, An Q, Sun CN, et al. Prognostic factors for breast cancer patients with T1–2 tumors and 1–3 positive lymph nodes and the role of postmastectomy radiotherapy in these patients. Breast Cancer, 2021, 28(2): 298-306.
18.	Wang S, Wen G, Tang Y, et al. Effectiveness of the AJCC 8th edition staging system for selecting patients with T1–2N1 breast cancer for post-mastectomy radiotherapy: a joint analysis of 1 986 patients from two institutions. BMC Cancer, 2020, 20(1): 792. doi: 10.1186/s12885-020-07267-5.
19.	Tang Y, Zhang YJ, Zhang N, et al. Nomogram predicting survival as a selection criterion for postmastectomy radiotherapy in patients with T1 to T2 breast cancer with 1 to 3 positive lymph nodes. Cancer, 2020, 126 Suppl 16: 3857-3866.
20.	Hou N, Zhang J, Yang L, et al. A prognostic risk stratification model to identify potential population benefiting from postmastectomy radiotherapy in T1–2 breast cancer with 1–3 positive axillary lymph nodes. Front Oncol, 2021, 11: 640268. doi: 10.3389/fonc.2021.640268.
21.	Luo C, Zhong X, Deng L, et al. Nomogram predicting locoregional recurrence to assist decision-making of postmastectomy radiation therapy in patients with T1–2N1 breast cancer. Int J Radiat Oncol Biol Phys, 2019, 103(4): 905-912.
22.	Mamounas EP, Liu Q, Paik S, et al. 21-gene recurrence score and locoregional recurrence in node-positive/ER-positive breast cancer treated with chemo-endocrine therapy. J Natl Cancer Inst, 2017, 109(4): djw259. doi: 10.1093/jnci/djw259.
23.	Goodman CR, Seagle BL, Kocherginsky M, et al. 21-gene recurrence score assay predicts benefit of post-mastectomy radiotherapy in T1-2N1 breast cancer. Clin Cancer Res, 2018, 24(16): 3878-3887.
24.	Zhang WW, Tong Q, Sun JY, et al. 21-gene recurrence score assay could not predict benefit of post-mastectomy radiotherapy in T1–2 N1mic ER-positive HER2-negative breast cancer. Front Oncol, 2019, 9: 270. doi: 10.3389/fonc.2019.00270.
25.	Thomssen C, Balic M, Harbeck N, et al. St. Gallen/Vienna 2021: a brief summary of the consensus discussion on customizing therapies for women with early breast cancer. Breast Care (Basel), 2021, 16(2): 135-143.
26.	Canadian Cancer Trials Group. TAILOR RT: a randomized trial of regional radiotherapy in biomarker low-risk node positive and T3N0 breast cancer. (2022-03-14)[2022-04-07]. https://clinicaltrials.gov/ct2/show/NCT03488693.
27.	Alliance for Clinical Trials in Oncology. A randomized phase Ⅲ trial comparing axillary lymph node dissection to axillary radiation in breast cancer patients (cT1–3 N1) who have positive sentinel lymph node disease after neoadjuvant chemotherapy. (2022-03-22)[2022-04-07]. https://clinicaltrials.gov/ct2/show/NCT01901094.
28.	Mamounas EP, Anderson SJ, Dignam JJ, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol, 2012, 30(32): 3960-3966.
29.	McGuire SE, Gonzalez-Angulo AM, Huang EH, et al. Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys, 2007, 68(4): 1004-1009.
30.	Novartis Pharmaceuticals. Neo ALTTO (Neoadjuvant lapatinib and/or trastuzumab treatment optimisation) study: a randomised, multicenter open-label phase Ⅲ study of neoadjuvant lapatinib, trastuzumab and their combination plus paclitaxel in women with HER2/ErbB2 positive primary breast cancer. (2021-08-24)[2022-05-23] .https://clinicaltrials.gov/ct2/show/NCT00553358.
31.	Huober J, Holmes E, Baselga J, et al. Survival outcomes of the NeoALTTO study (BIG 1-06): updated results of a randomised multicenter phase Ⅲ neoadjuvant clinical trial in patients with HER2-positive primary breast cancer. Eur J Cancer, 2019, 118: 169-177.
32.	Untch M, Jackisch C, Schneeweiss A, et al. Nab-paclitaxel versus solvent-based paclitaxel in neoadjuvant chemotherapy for early breast cancer (GeparSepto-GBG 69): a randomised, phase 3 trial. Lancet Oncol, 2016, 17(3): 345-356.
33.	Marks LB, Kaidar-Person O, Poortmans P. Regarding current recommendations for postmastectomy radiation therapy in patients with one to three positive axillary lymph nodes. J Clin Oncol, 2017, 35(11): 1256-1258.
34.	Zhang Y, Zhang Y, Liu Z, et al. Impact of postmastectomy radiotherapy on locoregional control and disease-free survival in patients with breast cancer treated with neoadjuvant chemotherapy. J Oncol, 2021, 2021: 6632635. doi: 10.1155/2021/6632635.
35.	程红莲, 王梦, 余岳, 等. 早期乳腺癌新辅助化疗淋巴结转阴患者术后放疗的价值. 天津医药, 2020, 48(1): 45-50.
36.	Wang Q, Zhao J, Han X, et al. Is there a role for post-mastectomy radiotherapy for T1–2N1 breast cancers with node-positive pathology after patients become node-negative pathology following neoadjuvant chemotherapy?. Front Oncol, 2020, 10: 892. doi: 10.3389/fonc.2020.00892.
37.	Wang Q, Zheng K, Zhang L, et al. The treatment process of an extremely rare giant borderline phyllodes tumor of breast: case report and literature review. Transl Cancer Res, 2021, 10(4): 1921-1929.
38.	NSABP Foundation inc. A randomized phase Ⅲ clinical trial evaluating post-mastectomy chestwall and regional nodal XRT and post-lumpectomy regional nodal XRT in patients with positive axillary nodes before neoadjuvant chemotherapy who convert to pathologically negative axillary nodes after neoadjuvant chemotherapy. (2021-10-04)[2022-04-13]. https://clinicaltrials.gov/ct2/show/NCT01872975.
39.	Huang Z, Zhu L, Huang XB, et al. Postmastectomy radiation therapy based on pathologic nodal status in clinical node-positive stage Ⅱ to Ⅲ breast cancer treated with neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys, 2020, 108(4): 1030-1039.
40.	Ma JC, Zhong XR, Luo T, et al. Correction to: the effect of postmastectomy radiotherapy on breast cancer patients after neoadjuvant chemotherapy by molecular subtype. Ann Surg Oncol, 2021, 28(Suppl 3): 870. doi: 10.1245/s10434-021-09771-9.
41.	Nikyar N, Tegnelius E, Valachis A. Adjuvant locoregional radiation therapy in breast cancer patients with pathologic complete response after neoadjuvant chemotherapy: a systematic review and meta-analysis. Clin Transl Radiat Oncol, 2022, 33: 45-52.
42.	刘黎, 许庆勇. 新辅助化疗后腋窝淋巴结阴性乳腺癌术后放疗的研究进展. 肿瘤研究与临床, 2022, 34(3): 233-237.
43.	Wang K, Jin X, Wang W, et al. The role of postmastectomy radiation in patients with ypN0 breast cancer after neoadjuvant chemotherapy: a meta-analysis. BMC Cancer, 2021, 21(1): 728. doi: 10.1186/s12885-021-08423-1.
44.	Lee J, Kim JY, Bae SJ, et al. The impact of post-mastectomy radiotherapy on survival outcomes in breast cancer patients who underwent neoadjuvant chemotherapy. Cancers (Basel), 2021, 13(24): 6205. doi: 10.3390/cancers13246205.
45.	Shah R, Hunter-Smith AE, Botes A, et al. Does post mastectomy radiotherapy reduce loco-regional recurrence rates in all clinical stages of breast cancer following a complete pathological response to neoadjuvant chemotherapy? A systematic review and meta-analysis of the literature. Breast Cancer Management, 2020, 9(2): BMT38. doi:10.2217/bmt-2020-0011.
46.	Krug D, Baumann R, Budach W, et al. 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, 194(7): 607-618.
47.	Kantor O, Pesce C, Singh P, et al. Post-mastectomy radiation therapy and overall survival after neoadjuvant chemotherapy. J Surg Oncol, 2017, 115(6): 668-676.

1. EBCTCG (Early Breast Cancer Trialists’ Collaborative Group), McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8 135 women in 22 randomised trials. Lancet, 2014, 383(9935): 2127-2135.
2. Chagpar AB. Debate: postmastectomy radiation therapy in T1/2N1 disease. Ann Surg Oncol, 2021, 28(10): 5456-5460.
3. Recht A, Comen EA, Fine RE, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update. J Clin Oncol, 2016, 34(36): 4431-4442.
4. Curigliano G, Burstein HJ, Winer EP, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol, 2017, 28(8): 1700-1712.
5. Senkus E, Kyriakides S, Ohno S, et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2015, 26 Suppl 5: v8-v30. doi: 10.1093/annonc/mdv298.
6. Frasier LL, Holden S, Holden T, et al. Temporal trends in postmastectomy radiation therapy and breast reconstruction associated with changes in National Comprehensive Cancer Network Guidelines. JAMA Oncol, 2016, 2(1): 95-101.
7. Abdel-Rahman O. Impact of postmastectomy radiotherapy on the outcomes of breast cancer patients with T1–2 N1 disease: an individual patient data analysis of three clinical trials. Strahlenther Onkol, 2019, 195(4): 297-305.
8. Wu SP, Tam M, Shaikh F, et al. Post-mastectomy radiation therapy in breast cancer patients with nodal micrometastases. Ann Surg Oncol, 2018, 25(9): 2620-2631.
9. Ohri N, Haffty BG. Is there a role for postmastectomy radiation (PMRT) in patients with T1–2 tumors and one to three positive lymph nodes treated in the modern era? Ann Surg Oncol, 2018, 25(7): 1788-1790.
10. Asaga S, Kinoshita T, Shiino S, et al. Prognostic factors for breast cancer patients with T1–2 tumor and 1–3 positive axillary nodes treated using total mastectomy without radiotherapy. Breast J, 2019, 25(1): 26-33.
11. McBride A, Allen P, Woodward W, et al. Locoregional recurrence risk for patients with T1, 2 breast cancer with 1–3 positive lymph nodes treated with mastectomy and systemic treatment. Int J Radiat Oncol Biol Phys, 2014, 89(2): 392-398.
12. Kayali M, Abi Jaoude J, Tfayli A, et al. Post-mastectomy radiation therapy in breast cancer patients with 1–3 positive lymph nodes: no one size fits all. Crit Rev Oncol Hematol, 2020, 147: 102880. doi: 10.1016/j.critrevonc.2020.102880.
13. Kaššák F, Rossier C, Picardi C, et al. Postmastectomy radiotherapy in T1–2 patients with one to three positive lymph nodes—Past, present and future. Breast, 2019, 48: 73-81.
14. Xu FF, Cao L, Xu C, et al. Practical model to optimize the strategy of adjuvant postmastectomy radiotherapy in T1–2N1 breast cancer with modern systemic therapy. Front Oncol, 2022, 12: 789198. doi: 10.3389/fonc.2022.789198.
15. Wang X, Zhang L, Zhang X, et al. Impact of clinical-pathological factors on locoregional recurrence in mastectomy patients with T1–2N1 breast cancer: who can omit adjuvant radiotherapy? Breast Cancer Res Treat, 2021, 190(2): 277-286.
16. Vohra LM, Soomro R, Jabeen D, et al. Utility of post mastectomy radiotherapy among patients with T1/ T2 N1 disease: a retrospective cohort study. Ann Med Surg (Lond), 2021, 65: 102295. doi: 10.1016/j.amsu.2021.102295.
17. Zhao JM, An Q, Sun CN, et al. Prognostic factors for breast cancer patients with T1–2 tumors and 1–3 positive lymph nodes and the role of postmastectomy radiotherapy in these patients. Breast Cancer, 2021, 28(2): 298-306.
18. Wang S, Wen G, Tang Y, et al. Effectiveness of the AJCC 8th edition staging system for selecting patients with T1–2N1 breast cancer for post-mastectomy radiotherapy: a joint analysis of 1 986 patients from two institutions. BMC Cancer, 2020, 20(1): 792. doi: 10.1186/s12885-020-07267-5.
19. Tang Y, Zhang YJ, Zhang N, et al. Nomogram predicting survival as a selection criterion for postmastectomy radiotherapy in patients with T1 to T2 breast cancer with 1 to 3 positive lymph nodes. Cancer, 2020, 126 Suppl 16: 3857-3866.
20. Hou N, Zhang J, Yang L, et al. A prognostic risk stratification model to identify potential population benefiting from postmastectomy radiotherapy in T1–2 breast cancer with 1–3 positive axillary lymph nodes. Front Oncol, 2021, 11: 640268. doi: 10.3389/fonc.2021.640268.
21. Luo C, Zhong X, Deng L, et al. Nomogram predicting locoregional recurrence to assist decision-making of postmastectomy radiation therapy in patients with T1–2N1 breast cancer. Int J Radiat Oncol Biol Phys, 2019, 103(4): 905-912.
22. Mamounas EP, Liu Q, Paik S, et al. 21-gene recurrence score and locoregional recurrence in node-positive/ER-positive breast cancer treated with chemo-endocrine therapy. J Natl Cancer Inst, 2017, 109(4): djw259. doi: 10.1093/jnci/djw259.
23. Goodman CR, Seagle BL, Kocherginsky M, et al. 21-gene recurrence score assay predicts benefit of post-mastectomy radiotherapy in T1-2N1 breast cancer. Clin Cancer Res, 2018, 24(16): 3878-3887.
24. Zhang WW, Tong Q, Sun JY, et al. 21-gene recurrence score assay could not predict benefit of post-mastectomy radiotherapy in T1–2 N1mic ER-positive HER2-negative breast cancer. Front Oncol, 2019, 9: 270. doi: 10.3389/fonc.2019.00270.
25. Thomssen C, Balic M, Harbeck N, et al. St. Gallen/Vienna 2021: a brief summary of the consensus discussion on customizing therapies for women with early breast cancer. Breast Care (Basel), 2021, 16(2): 135-143.
26. Canadian Cancer Trials Group. TAILOR RT: a randomized trial of regional radiotherapy in biomarker low-risk node positive and T3N0 breast cancer. (2022-03-14)[2022-04-07]. https://clinicaltrials.gov/ct2/show/NCT03488693.
27. Alliance for Clinical Trials in Oncology. A randomized phase Ⅲ trial comparing axillary lymph node dissection to axillary radiation in breast cancer patients (cT1–3 N1) who have positive sentinel lymph node disease after neoadjuvant chemotherapy. (2022-03-22)[2022-04-07]. https://clinicaltrials.gov/ct2/show/NCT01901094.
28. Mamounas EP, Anderson SJ, Dignam JJ, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol, 2012, 30(32): 3960-3966.
29. McGuire SE, Gonzalez-Angulo AM, Huang EH, et al. Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys, 2007, 68(4): 1004-1009.
30. Novartis Pharmaceuticals. Neo ALTTO (Neoadjuvant lapatinib and/or trastuzumab treatment optimisation) study: a randomised, multicenter open-label phase Ⅲ study of neoadjuvant lapatinib, trastuzumab and their combination plus paclitaxel in women with HER2/ErbB2 positive primary breast cancer. (2021-08-24)[2022-05-23] .https://clinicaltrials.gov/ct2/show/NCT00553358.
31. Huober J, Holmes E, Baselga J, et al. Survival outcomes of the NeoALTTO study (BIG 1-06): updated results of a randomised multicenter phase Ⅲ neoadjuvant clinical trial in patients with HER2-positive primary breast cancer. Eur J Cancer, 2019, 118: 169-177.
32. Untch M, Jackisch C, Schneeweiss A, et al. Nab-paclitaxel versus solvent-based paclitaxel in neoadjuvant chemotherapy for early breast cancer (GeparSepto-GBG 69): a randomised, phase 3 trial. Lancet Oncol, 2016, 17(3): 345-356.
33. Marks LB, Kaidar-Person O, Poortmans P. Regarding current recommendations for postmastectomy radiation therapy in patients with one to three positive axillary lymph nodes. J Clin Oncol, 2017, 35(11): 1256-1258.
34. Zhang Y, Zhang Y, Liu Z, et al. Impact of postmastectomy radiotherapy on locoregional control and disease-free survival in patients with breast cancer treated with neoadjuvant chemotherapy. J Oncol, 2021, 2021: 6632635. doi: 10.1155/2021/6632635.
35. 程红莲, 王梦, 余岳, 等. 早期乳腺癌新辅助化疗淋巴结转阴患者术后放疗的价值. 天津医药, 2020, 48(1): 45-50.
36. Wang Q, Zhao J, Han X, et al. Is there a role for post-mastectomy radiotherapy for T1–2N1 breast cancers with node-positive pathology after patients become node-negative pathology following neoadjuvant chemotherapy?. Front Oncol, 2020, 10: 892. doi: 10.3389/fonc.2020.00892.
37. Wang Q, Zheng K, Zhang L, et al. The treatment process of an extremely rare giant borderline phyllodes tumor of breast: case report and literature review. Transl Cancer Res, 2021, 10(4): 1921-1929.
38. NSABP Foundation inc. A randomized phase Ⅲ clinical trial evaluating post-mastectomy chestwall and regional nodal XRT and post-lumpectomy regional nodal XRT in patients with positive axillary nodes before neoadjuvant chemotherapy who convert to pathologically negative axillary nodes after neoadjuvant chemotherapy. (2021-10-04)[2022-04-13]. https://clinicaltrials.gov/ct2/show/NCT01872975.
39. Huang Z, Zhu L, Huang XB, et al. Postmastectomy radiation therapy based on pathologic nodal status in clinical node-positive stage Ⅱ to Ⅲ breast cancer treated with neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys, 2020, 108(4): 1030-1039.
40. Ma JC, Zhong XR, Luo T, et al. Correction to: the effect of postmastectomy radiotherapy on breast cancer patients after neoadjuvant chemotherapy by molecular subtype. Ann Surg Oncol, 2021, 28(Suppl 3): 870. doi: 10.1245/s10434-021-09771-9.
41. Nikyar N, Tegnelius E, Valachis A. Adjuvant locoregional radiation therapy in breast cancer patients with pathologic complete response after neoadjuvant chemotherapy: a systematic review and meta-analysis. Clin Transl Radiat Oncol, 2022, 33: 45-52.
42. 刘黎, 许庆勇. 新辅助化疗后腋窝淋巴结阴性乳腺癌术后放疗的研究进展. 肿瘤研究与临床, 2022, 34(3): 233-237.
43. Wang K, Jin X, Wang W, et al. The role of postmastectomy radiation in patients with ypN0 breast cancer after neoadjuvant chemotherapy: a meta-analysis. BMC Cancer, 2021, 21(1): 728. doi: 10.1186/s12885-021-08423-1.
44. Lee J, Kim JY, Bae SJ, et al. The impact of post-mastectomy radiotherapy on survival outcomes in breast cancer patients who underwent neoadjuvant chemotherapy. Cancers (Basel), 2021, 13(24): 6205. doi: 10.3390/cancers13246205.
45. Shah R, Hunter-Smith AE, Botes A, et al. Does post mastectomy radiotherapy reduce loco-regional recurrence rates in all clinical stages of breast cancer following a complete pathological response to neoadjuvant chemotherapy? A systematic review and meta-analysis of the literature. Breast Cancer Management, 2020, 9(2): BMT38. doi:10.2217/bmt-2020-0011.
46. Krug D, Baumann R, Budach W, et al. 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, 194(7): 607-618.
47. Kantor O, Pesce C, Singh P, et al. Post-mastectomy radiation therapy and overall survival after neoadjuvant chemotherapy. J Surg Oncol, 2017, 115(6): 668-676.

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