Highlights
- •In high-risk breast cancer, longer time from surgery to endocrine therapy was associated with worse recurrence-free survival.
- •High-risk patients may benefit from early systemic endocrine therapy, and delays may have negative oncologic consequences.
- •Delaying endocrine therapy in patients receiving radiotherapy should be carefully considered, weighing patient risk factors
Abstract
Background
In hormone receptor-positive breast cancer (HRPBC), endocrine therapy is often initiated
after adjuvant radiotherapy given concerns of radiation fibrosis. No studies have
investigated how this may impact outcomes in high-risk patients undergoing neoadjuvant
chemotherapy (NAC).
Methods
Females with nonmetastatic HRPBC receiving NAC from 2011 to 2017 were identified from
our multi-institutional database. Interval from surgery to endocrine therapy (ISET)
was calculated in weeks. Recurrence-free survival (RFS) and overall survival (OS)
were evaluated with Kaplan-Meier and Cox proportional hazards modeling.
Results
Of 280 patients, 179 (64%) received adjuvant radiotherapy; all deaths (n = 25) and
90% (n = 27) of recurrences occurred in this group, which was the focus of subsequent
analysis.
Median follow-up was 49 months. Recurrences were predominantly distant metastases
(n = 21, 81%). Median ISET was 12 weeks (range 0–55 weeks). On multivariable analysis,
ISET >14 weeks was independently associated with worse RFS (HR 3.20, 95% C.I. 1.22–8.40,
P = 0.02) but not OS (HR 2.15, 95% C.I. 0.75–6.15, P = 0.15).
Conclusion
In patients with HRPBC treated with NAC and adjuvant radiation, increasing ISET is
associated with adverse oncologic outcomes.
Keywords
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Article info
Publication history
Published online: February 24, 2023
Accepted:
February 23,
2023
Received in revised form:
January 12,
2023
Received:
November 5,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
