Patterns of Failure in Women Who Have Residual Nodal Disease After Neoadjuvant Chemotherapy for Breast Cancer According to Extent of Lymph Node Surgery

Autor: Margaret M. Kozak, Frederick M. Dirbas, Emily Walck, Rie von Eyben, Clare E. Jacobson, Kathleen C. Horst, Paulina M. Gutkin
Rok vydání: 2020
Předmět:
Adult
0301 basic medicine
Cancer Research
medicine.medical_specialty
Neoplasm
Residual
Receptor
ErbB-2
medicine.medical_treatment
Sentinel lymph node
Breast Neoplasms
Mastectomy
Segmental
Young Adult
03 medical and health sciences
0302 clinical medicine
Breast cancer
Antineoplastic Combined Chemotherapy Protocols
Biopsy
medicine
Humans
Treatment Failure
Lymph node
Mastectomy
Aged
Retrospective Studies
Chemotherapy
medicine.diagnostic_test
Sentinel Lymph Node Biopsy
business.industry
Carcinoma
Ductal
Breast
Axillary Lymph Node Dissection
Middle Aged
medicine.disease
Combined Modality Therapy
Neoadjuvant Therapy
Surgery
Clinical trial
Carcinoma
Lobular
Axilla
030104 developmental biology
medicine.anatomical_structure
Receptors
Estrogen
Oncology
030220 oncology & carcinogenesis
Lymph Node Excision
Female
Lymph Nodes
Receptors
Progesterone
business
Follow-Up Studies
Zdroj: Clinical Breast Cancer. 20:431-438
ISSN: 1526-8209
DOI: 10.1016/j.clbc.2020.04.008
Popis: Background Optimal surgical management of limited axillary nodal disease following neoadjuvant chemotherapy (NAC) for breast cancer is evolving. Concerns exist with respect to leaving residual disease in the axilla when omitting axillary lymph node dissection (ALND) in this setting. We sought to determine whether extent of nodal surgery altered patterns of failure and patient outcomes. Patients and Methods We identified 70 patients with breast cancer who were confirmed cN0 after NAC yet had residual nodal disease (ypN1) on sentinel lymph node biopsy (SLNB). Twenty-eight patients underwent SLNB alone and 42 underwent SLNB+completion (c)ALND in a non-randomized fashion. Most (n = 65) patients underwent adjuvant regional nodal irradiation (RNI). Detailed patterns of failure data were obtained for each patient. Results The median follow-up was 43.5 months. There were 30 (43%) recurrences. Of these, 5 were isolated locoregional failures, and 24 were distant failures. There were no significant differences in local (P = .13), regional (P = .62), or distant (P = .47) failure between patients who underwent SLNB alone versus SLNB+cALND. Seventeen (24%) patients died. Overall survival was similar in both groups with median overall survival not reached for those who underwent SLNB and 109 months for those who underwent SLNB+cALND (P = .45). Conclusions There were no differences in patterns of recurrence among patients with 1 to 3 involved lymph nodes after NAC who underwent SLNB alone versus SLNB+cALND in the setting of RNI. We await the results of ongoing, prospective clinical trials to confirm the relative merits of RNI in lieu of cALND in these patients.
Databáze: OpenAIRE
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