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

Published:January 12, 2022DOI:https://doi.org/10.1016/j.clbc.2022.01.001

      Abstract

      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 metastases size and modern sentinel lymph node evaluation techniques. We aimed to determine prognostic factors for patients 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 = 0.82). 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 = 0.025), and 100% in patients receiving comprehensive nodal irradiation versus 76.7% in patients receiving whole breast irradiation or no RT (p = 0.045).

      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.
      MicroAbstract
      Optimal adjuvant radiotherapy fields in patients with micrometastases are controversial. In this retrospective study, 156 patients with micrometastases were analyzed. Women with grade 3 histology were observed to be at substantial risk for LRR. Adjuvant RT was associated with a lower risk of LRR. Adjuvant RT, including comprehensive nodal irradiation, should be strongly considered for women with grade 3 micrometastases.

      Key Words

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