De-escalating Locoregional Therapy for Axillary Micrometastases in Breast Cancer: How Much is Too Much?

Autor: Merfeld EC; Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI. Electronic address: emerfeld@uwhealth.org., Burr AR; Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI., Brickson C; Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI., Neuman HB; Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI., Anderson BM; Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Jazyk: angličtina
Zdroj: Clinical breast cancer [Clin Breast Cancer] 2022 Jun; Vol. 22 (4), pp. 336-342. Date of Electronic Publication: 2022 Jan 12.
DOI: 10.1016/j.clbc.2022.01.001
Abstrakt: Background: The applicability of modern prospective data on adjuvant radiotherapy (RT) fields in patients with micrometastases is limited because many trials occurred prior to routine measurement of nodal metastasis size and modern sentinel lymph node evaluation techniques. We aimed to determine prognostic factors for patients with micrometastases and evaluate the impact of adjuvant RT on disease outcomes.
Patients and Methods: Patients diagnosed with pathologic T1-T3 N1mi breast cancers between 2004-2015 were identified. Cox proportional hazards methods were used to determine characteristics predictive of locoregional recurrence (LRR). Tumor and treatment-specific factors were further evaluated using log-rank statistics to compare rates of LRR-free survival.
Results: This analysis included 156 patients. On multivariable analysis, grade 3 histology (HR 10.84, 95% CI 2.72-43.21) and adjuvant RT (HR 0.22, 95% CI 0.06-0.81) were independent predictors of LRR. Among patients with grade 1-2 histology, 5-year LRR-free survival was 98.8% in patients who received adjuvant RT versus 100% in patients who did not receive adjuvant RT (P = .82). Among patients with grade 3 histology, 5-year LRR-free survival was 90.1% in patients who received adjuvant RT versus 53.0% in patients who did not receive adjuvant RT (P = .025), and 100% in patients receiving comprehensive nodal irradiation versus 76.7% in patients receiving whole breast irradiation or no RT (P = .045).
Conclusion: Patients with grade 3 micrometastases are at substantial risk for LRR. Adjuvant RT, including comprehensive nodal irradiation, should be strongly considered in these women.
(Copyright © 2022. Published by Elsevier Inc.)
Databáze: MEDLINE
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