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@ARTICLE{Haussmann:291985,
      author       = {J. Haussmann and W. Budach and C. Nestle-Krämling and S.
                      Wollandt and D. Jazmati and B. Tamaskovics and S. Corradini
                      and E. Bölke and A. Haussmann$^*$ and W. Audretsch and C.
                      Matuschek},
      title        = {{F}actors influencing pathological complete response and
                      tumor regression in neoadjuvant radiotherapy and
                      chemotherapy for high-risk breast cancer.},
      journal      = {Radiation oncology},
      volume       = {19},
      number       = {1},
      issn         = {1748-717X},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DKFZ-2024-01568},
      pages        = {99},
      year         = {2024},
      abstract     = {Pathological complete response (pCR) is a well-established
                      prognostic factor in breast cancer treated with neoadjuvant
                      systemic therapy (naST). The determining factors of pCR are
                      known to be intrinsic subtype, proliferation index, grading,
                      clinical tumor and nodal stage as well as type of systemic
                      therapy. The addition of neoadjuvant radiotherapy (naRT) to
                      this paradigm might improve response, freedom from disease,
                      toxicity and cosmetic outcome compared to adjuvant
                      radiotherapy. The factors for pCR and primary tumor
                      regression when neoadjuvant radiation therapy is added to
                      chemotherapy have not been thoroughly described.We performed
                      a retrospective analysis of 341 patients (cT1-cT4/cN0-N+)
                      treated with naRT and naST between 1990 and 2003. Patients
                      underwent naRT to the breast and mostly to the
                      supra-/infraclavicular lymph nodes combined with an electron
                      or brachytherapy boost. NaST was given either sequentially
                      or simultaneously to naRT using different regimens. We used
                      the univariate and multivariate regression analysis to
                      estimate the effect of different subgroups and treatment
                      modalities on pCR (ypT0/Tis and ypN0) as well as complete
                      primary tumor response (ypT0/Tis; bpCR) in our cohort.
                      Receiver operating characteristic (ROC) analysis was
                      performed to evaluate the interval between radiotherapy (RT)
                      and resection (Rx) as well as radiotherapy dose.Out of 341
                      patients, pCR and pbCR were achieved in $31\%$ and $39\%,$
                      respectively. pCR rate was influenced by resection type,
                      breast cancer subtype, primary tumor stage and interval from
                      radiation to surgery in the multivariate analysis.
                      Univariate analysis of bpCR showed age, resection type,
                      breast cancer subtype, clinical tumor stage and grading as
                      significant factors. Resection type, subtype and clinical
                      tumor stage remained significant in multivariate analysis.
                      Radiation dose to the tumor and interval from radiation to
                      surgery were not significant factors for pCR. However, when
                      treatment factors were added to the model, a longer interval
                      from radiotherapy to resection was a significant predictor
                      for pCR.The factors associated with pCR following naST and
                      naRT are similar to known factors after naST alone. Longer
                      interval to surgery might to be associated with higher pCR
                      rates. Dose escalation beyond 60 Gy did not result in higher
                      response rates.},
      keywords     = {Humans / Female / Breast Neoplasms: pathology / Breast
                      Neoplasms: radiotherapy / Breast Neoplasms: therapy /
                      Neoadjuvant Therapy / Middle Aged / Retrospective Studies /
                      Adult / Aged / Radiotherapy, Adjuvant / Prognosis /
                      Antineoplastic Combined Chemotherapy Protocols: therapeutic
                      use / Treatment Outcome / ROC Curve / Breast cancer (Other)
                      / Breast response (Other) / Neoadjuvant chemotherapy (Other)
                      / Neoadjuvant radiotherapy (Other) / pCR (Other)},
      cin          = {C110},
      ddc          = {610},
      cid          = {I:(DE-He78)C110-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:39085866},
      pmc          = {pmc:PMC11293047},
      doi          = {10.1186/s13014-024-02450-5},
      url          = {https://inrepo02.dkfz.de/record/291985},
}