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Breast Cancer Research and Treatment

, Volume 125, Issue 3, pp 893–902 | Cite as

A 10-year follow-up of treatment outcomes in patients with early stage breast cancer and clinically negative axillary nodes treated with tangential breast irradiation following sentinel lymph node dissection or axillary clearance

  • A. Gabriella Wernicke
  • Robert L. Goodman
  • Bruce C. Turner
  • Lydia T. Komarnicky
  • Walter J. Curran
  • Paul J. Christos
  • Imraan Khan
  • Katherine Vandris
  • Bhupesh Parashar
  • Dattatreyudu Nori
  • K. S. Clifford Chao
Brief Report

Abstract

We compare long-term outcomes in patients with node negative early stage breast cancer treated with breast radiotherapy (RT) without the axillary RT field after sentinel lymph node dissection (SLND) or axillary lymph node dissection (ALND). We hypothesize that though tangential RT was delivered to the breast tissue, it at least partially sterilized occult axillary nodal metastases thus providing low nodal failure rates. Between 1995 and 2001, 265 patients with AJCC stages I–II breast cancer were treated with lumpectomy and either SLND (cohort SLND) or SLND and ALND (cohort ALND). Median follow-up was 9.9 years (range 8.3–15.3 years). RT was administered to the whole breast to the median dose of 48.2 Gy (range 46.0–50.4 Gy) plus boost without axillary RT. Chi-square tests were employed in comparing outcomes of two groups for axillary and supraclavicular failure rates, ipsilateral in-breast tumor recurrence (IBTR), distant metastases (DM), and chronic complications. Progression-free survival (PFS) was compared using log-rank test. There were 136/265 (51%) and 129/265 (49%) patients in the SLND and ALND cohorts, respectively. The median number of axillary lymph nodes assessed was 2 (range 1–5) in cohort SLND and 18 (range 7–36) in cohort ALND (P < 0.0001). Incidence of AFR and SFR in both cohorts was 0%. The rates of IBTR and DM in both cohorts were not significantly different. Median PFS in the SLND cohort is 14.6 years and 10-year PFS is 88.2%. Median PFS in the ALND group is 15.0 years and 10-year PFS is 85.7%. At a 10-year follow-up chronic lymphedema occurred in 5/108 (4.6%) and 40/115 (34.8%) in cohorts SLND and ALND, respectively (P = 0.0001). This study provides mature evidence that patients with negative nodes, treated with tangential breast RT and SLND alone, experience low AFR or SFR. Our findings, while awaiting mature long-term data from NSABP B-32, support that in patients with negative axillary nodal status such treatment provides excellent long-term cure rates while avoiding morbidities associated with ALND or addition of axillary RT field.

Keywords

Sentinel lymph node sampling Axillary lymph node dissection Breast cancer Tangential breast radiotherapy Radiotherapy 

Abbreviations

AFR

Axillary failure rates

SLN

Sentinel lymph node

ALN

Axillary lymph node

SLND

Sentinel lymph node dissection

ALND

Axillary lymph node dissection

IBTR

Ipsilateral breast tumor recurrence

DM

Distant metastases

BCT

Breast conserving therapy

SFR

Supraclavicular failure rates

RT

Radiotherapy

ER

Estrogen receptor

PR

Progesterone receptor

L

Lumpectomy

MRM

Modified radical mastectomy

Notes

Acknowledgments

Dr. Paul Christos was partially supported by the following grant: Clinical Translational Science Center (CTSC) (UL1-RR024996).

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • A. Gabriella Wernicke
    • 1
  • Robert L. Goodman
    • 2
  • Bruce C. Turner
    • 3
  • Lydia T. Komarnicky
    • 4
  • Walter J. Curran
    • 5
  • Paul J. Christos
    • 6
  • Imraan Khan
    • 7
  • Katherine Vandris
    • 8
  • Bhupesh Parashar
    • 1
  • Dattatreyudu Nori
    • 1
  • K. S. Clifford Chao
    • 1
  1. 1.Department of Radiation Oncology, Stich Radiation OncologyWeil Cornell Medical College of Cornell UniversityNew YorkUSA
  2. 2.Department of Radiation OncologySaint Barnabas Medical CenterLivingstonUSA
  3. 3.Department of Radiation OncologyThomas Jefferson University HospitalPhiladelphiaUSA
  4. 4.Department of Radiation OncologyDrexel University HospitalPhiladelphiaUSA
  5. 5.Department of Radiation OncologyEmory University School of MedicineAtlantaUSA
  6. 6.Division of Biostatistics and Epidemiology, Department of Public HealthWeill Cornell Medical College of Cornell UniversityNew YorkUSA
  7. 7.Department of Biological SciencesState University of New YorkStony BrookUSA
  8. 8.Division of Hematology/Medical Oncology, Department of MedicineWeill Cornell Medical College of Cornell UniversityNew YorkUSA

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