Long-term results of preoperative hypofractionated chemoradiotherapy for high-risk HER2-positive and triple-negative breast cancer subtypes.

Authors

Raquel Ciérvide, Ángel Montero, Mariola García-Aranda, Jeannette Valero, Beatriz Álvarez, Xin Chen, Rosa Alonso, Mercedes López, Ovidio Hernando, Emilio Sánchez, Carmen Rubio

Published in

Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico. Aug 08, 2026. Epub Aug 08, 2026.

Abstract

Concurrent chemoradiotherapy is an established treatment modality for several solid malignancies, whereas its role in breast cancer remains investigational. This study reports the five-year efficacy, safety, and survival outcomes of preoperative concurrent chemoradiotherapy (PCRT) in patients with HER2-positive and triple-negative breast cancer.
This is a prospective single-center pilot study that includes 62 patients with non-metastatic HER2-positive or triple-negative breast cancer treated between 2018 and 2022. Patients received hypo-fractionated radiotherapy (40.5 Gy/15 fractions with a simultaneous integrated boost to 54 Gy to the macroscopic tumor using 18-FDG-PET-CT) delivered concurrently with subtype-specific systemic therapy, followed by surgery. Surgery was performed 4-6 weeks after PCRT. Primary endpoints included pathological complete response (pCR), toxicity, and long-term oncological outcomes.
Between September 2018 and August 2022, 62 patients were enrolled (median age 53 years). Tumor subtypes were 28 TN (45%) and 34 HER2 + (55%). 60 patients completed preoperative concurrent chemo-radiotherapy. Breast-conserving surgery was achieved in 68% of cases. Pathologic complete response (pCR, Miller-Payne's Grade 5) was obtained in 60% overall-70% in TN and 52% in HER2 + patients. No grade ≥ 3 late toxicity was observed. A total of 43% of patients experienced G2, 26% G3, and 13.7% G4 cytopenia. Transient asymptomatic declines in left ventricular ejection fraction occurred in 7% of HER2-positive patients and resolved completely during follow-up. Two patients died before surgery, one from chemotherapy-related sepsis and one from causes unrelated to treatment. With a median follow-up of 60.7 months, 5-year locoregional recurrence-free survival was 100%, disease-free survival 95%, distant metastasis-free survival 95%, and overall survival 95%. A total of 2 patients (3%) developed an independent contralateral primary breast tumor during the follow-up; both cases were treated according to standard protocols, and both remain free of disease to date. However, a total of 3 patients experienced distant disease recurrence. Only one death was cancer-related. Cosmetic results were rated as excellent or good in all breast-conserving cases. Out of the 19 patients (32%) who underwent mastectomy, a breast reconstruction was performed in 11 patients. Reconstruction-outcomes favored autologous over heterologous techniques (p = 0.003). No significant correlation was found between pCR and survival.
Preoperative hypo-fractionated concurrent chemo-radiotherapy demonstrated encouraging long-term local control, survival, and acceptable toxicity in selected patients with HER2-positive and triple-negative breast cancer. Although these findings support the feasibility of this strategy, confirmation in larger prospective randomized studies is warranted.

PMID:
42570990
Bibliographic data and abstract were imported from PubMed on 09 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.