Axillary micrometastases and isolated tumor cells are not an indication for post-mastectomy radiotherapy in stage 1 and 2 breast cancer Journal Article
| Authors: | Mamtani, A.; Patil, S.; Stempel, M.; Morrow, M. |
| Article Title: | Axillary micrometastases and isolated tumor cells are not an indication for post-mastectomy radiotherapy in stage 1 and 2 breast cancer |
| Abstract: | Background: Randomized trials demonstrate equivalent locoregional control with sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) for T1–2 micrometastatic breast cancer, but include few mastectomy patients. Consensus is lacking on indications for post-mastectomy radiotherapy (PMRT) in this population. Herein, we evaluate locoregional recurrence (LRR) in an unselected, modern cohort of T1–2 breast cancer patients with micrometastases or isolated tumor cells (ITCs; N0i+/N1mi) having a mastectomy. Methods: We identified patients with T1–2N0i+/N1mi breast cancer treated with mastectomy from January 2006 to December 2011. Recurrent, bilateral, and neoadjuvant cases were excluded. The primary outcome of interest was LRR. Results: Overall, 352 patients [211 (60%) with ITCs and 141 (40%) with micrometastases] were identified. 162 (46%) patients had SLNB alone and one node was positive in 295 (84%) cases; 31 (9%) patients had PMRT and 95% had systemic therapy. At a median 6 years of follow-up, the overall crude LRR rate was 2.8% (n = 9), with no axillary recurrences, and the crude LRR rate was 3.9% among those who had SNB alone. Those with LRR had a median age of 55 years, median tumor size of 1.7 cm, and ductal histology; the majority were high-grade (89%) and estrogen receptor positive (78%), with one positive node (89%). There was no association between LRR and receipt of PMRT (p = 0.4), SLNB versus ALND (p = 0.2), or number of positive nodes (p = 0.7) using the log-rank test. Conclusions: LRR was infrequent among T1–2N0i+/N1mi patients treated with mastectomy without PMRT, with no axillary failures, suggesting that PMRT or nodal radiotherapy are not routinely indicated in this population. © 2017, Society of Surgical Oncology. |
| Keywords: | cancer surgery; major clinical study; cancer patient; cancer radiotherapy; postoperative care; cancer staging; recurrence risk; follow up; sentinel lymph node biopsy; breast cancer; tumor volume; cohort analysis; partial mastectomy; tumor cell; cell isolation; micrometastasis; locoregional recurrence; oncological parameters; human; article |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 24 |
| Issue: | 8 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2017-08-01 |
| Start Page: | 2182 |
| End Page: | 2188 |
| Language: | English |
| DOI: | 10.1245/s10434-017-5866-7 |
| PROVIDER: | scopus |
| PUBMED: | 28429197 |
| PMCID: | PMC5568787 |
| DOI/URL: | |
| Notes: | Erratum issued, see DOI: 10.1245/s10434-017-6004-2 -- Article -- Export Date: 1 August 2017 -- Source: Scopus |
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