Neoadjuvant Response Is Redefining Local Therapy Across Cancer Types

Background: Adjuvant irradiation improves survival for early stage breast cancer patients who undergo surgery and have axillary disease, regardless of the number of involved nodes. Neoadjuvant chemotherapy can allow some women the option of lumpectomy. As neoadjuvant chemotherapy has become more popular, a common scenario is a patient presenting with axillary adenopathy, having a pathologic complete response to neoadjuvant chemotherapy at surgery (ypN0), and then presenting for consideration of adjuvant radiation therapy (XRT). Objective: To determine whether regional XRT increases freedom from recurrence of breast cancer in patients with clinically positive nodes who undergo neoadjuvant chemotherapy and achieve ypN0. Design: Prospective, phase III, international randomized trial. Participants: Eligible patients had operable T1 to T3, N1 (1 to 3 nodes), M0 breast cancer. Pathologic confirmation of a positive node was required (fine-needle aspiration or core-needle biopsy). Methods: S more...