How often do sentinel lymph node biopsy results affect adjuvant therapy decisions among postmenopausal women with early-stage HR+/HER2− breast cancer in the post-RxPONDER era? Journal Article

   

Authors:	Pilewskie, M.; Sevilimedu, V.; Eroglu, I.; Le, T.; Wang, R.; Morrow, M.; Braunstein, L. Z.
Article Title:	How often do sentinel lymph node biopsy results affect adjuvant therapy decisions among postmenopausal women with early-stage HR+/HER2− breast cancer in the post-RxPONDER era?
Abstract:	Background: The RxPONDER trial reported no benefit to chemotherapy among postmenopausal patients with HR+/HER2− tumors, one to three positive nodes, and low recurrence scores, questioning the role of axillary staging in this population. Here, we evaluate the impact of sentinel lymph node biopsy (SLNB) results on adjuvant therapy decisions in postmenopausal women with HR+/HER2− breast cancer. Patients and Methods: Postmenopausal women with cT1–2N0, HR+/HER2− breast cancer treated with lumpectomy and SLNB from 2012 to 2018 were identified. Receipt of nodal irradiation, indication for axillary lymph node dissection (ALND) and chemotherapy, and partial breast irradiation (PBI) eligibility were reviewed with pre- and post-SLNB results. Results: A total of 1786 women were identified: median age 62 years, 84% with pT1 tumors, and 16% with pT2–3 tumors. Of those, 85% (n = 1525) remained pN0, 14% (n = 244) were pN1, and 1% (n = 17) were pN2–3. A total of 20 (1%) patients had > 2 positive SLNs, necessitating ALND. Pre-SLNB, 1478 women were considered PBI eligible; post-SLNB, 227 (13%) converted to PBI ineligible. In total, 58 patients with positive nodes received nodal irradiation, representing 3% of the entire cohort and 22% of pN+ patients. Overall, 1401 patients had an Oncotype DX recurrence score available, including 1273 patients with pN0 stage and 128 with pN1, with 173 (14%) and 16 (13%), respectively, having a recurrence score > 25, warranting chemotherapy. Conclusions: While few cN0 postmenopausal women with HR+/HER2− tumors had nodal pathology that warranted ALND, receipt of nodal irradiation, or indicated need for chemotherapy, in 13%, SLNB would have an impact on consideration for PBI. Among patients eligible for PBI, findings from SLNB may help refine selection among postmenopausal women with this tumor profile. © 2022, Society of Surgical Oncology.
Keywords:	adult; cancer chemotherapy; human tissue; middle aged; major clinical study; cancer recurrence; cancer adjuvant therapy; cancer staging; antineoplastic agent; lymph node dissection; neoplasm staging; sentinel lymph node; lymph node excision; sentinel lymph node biopsy; medical decision making; tumor volume; cohort analysis; practice guideline; pathology; breast neoplasms; early cancer; breast tumor; recurrent disease; surgery; axilla; hormone receptor; postmenopause; lumpectomy; axillary lymph node dissection; procedures; lymph vessel metastasis; humans; human; female; article; breast radiotherapy; hormone receptor-positive, her2-negative breast cancer
Journal Title:	Annals of Surgical Oncology
Volume:	29
Issue:	10
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2022-10-01
Start Page:	6267
End Page:	6273
Language:	English
DOI:	10.1245/s10434-022-12193-w
PUBMED:	35849294
PROVIDER:	scopus
PMCID:	PMC10286823
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85134535589&doi=10.1245%2fs10434-022-12193-w&partnerID=40&md5=f9d663ab996e72ebc548e977e63a9920
Notes:	Article -- Export Date: 3 October 2022 -- Source: Scopus

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