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Axillary Micrometastases and Isolated Tumor Cells Are Not an Indication for Post-mastectomy Radiotherapy in Stage 1 and 2 Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

An Erratum to this article was published on 17 July 2017

This article has been updated

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.

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Change history

  • 17 July 2017

    An erratum to this article has been published.

References

  1. Houvenaeghel G, Classe JM, Garbay JR, et al. Prognostic value of isolated tumor cells and micrometastases of lymph nodes in early-stage breast cancer: a French sentinel node multicenter cohort study. Breast. 2014;23(5):561–566.

    Article  PubMed  Google Scholar 

  2. Cserni G, Bianchi S, Vezzosi V, et al. Variations in sentinel node isolated tumour cells/micrometastasis and non-sentinel node involvement rates according to different interpretations of the TNM definitions. Eur J Cancer. 2008;44(15):2185–2191.

    Article  PubMed  Google Scholar 

  3. Yi M, Giordano SH, Meric-Bernstam F, et al. Trends in and outcomes from sentinel lymph node biopsy (SLNB) alone vs. SLNB with axillary lymph node dissection for node-positive breast cancer patients: experience from the SEER database. Ann Surg Oncol. 2010;17 Suppl 3:343–351.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297–305.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sola M, Alberro JA, Fraile M, et al. Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048/13/2000. Ann Surg Oncol. 2013;20(1):120–127.

    Article  PubMed  Google Scholar 

  6. de Boer M, van Deurzen CH, van Dijck JA, et al. Micrometastases or isolated tumor cells and the outcome of breast cancer. N Engl J Med. 2009;361(7):653–663.

    Article  PubMed  Google Scholar 

  7. Recht A, Comen EA, Fine RE, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update. J Clin Oncol. 2016;34(36):4431–4444.

    Article  PubMed  Google Scholar 

  8. Sharma R, Bedrosian I, Lucci A, et al. Present-day locoregional control in patients with t1 or t2 breast cancer with 0 and 1 to 3 positive lymph nodes after mastectomy without radiotherapy. Ann Surg Oncol. 2010;17(11):2899–2908.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wallgren A, Bonetti M, Gelber RD, et al. Risk factors for locoregional recurrence among breast cancer patients: results from International Breast Cancer Study Group Trials I through VII. J Clin Oncol. 2003;21(7):1205–1213.

    Article  CAS  PubMed  Google Scholar 

  10. Poortmans PM, Collette S, Kirkove C, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015;373(4):317–327.

    Article  CAS  PubMed  Google Scholar 

  11. Whelan TJ, Olivotto IA, Parulekar WR, et al. Regional Nodal Irradiation in Early-Stage Breast Cancer. N Engl J Med. 2015;373(4):307–316.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–1474.

    Article  PubMed  Google Scholar 

  13. Mamtani A, Patil S, Stempel M, Morrow M. Are there patients with T1–T2, lymph node-negative breast cancer who are “high-risk” for locoregional recurrence? Cancer. Epub 23 Mar 2017.

  14. Tallet A, Lambaudie E, Cohen M, et al. Locoregional treatment of early breast cancer with isolated tumor cells or micrometastases on sentinel lymph node biopsy. World J Clin Oncol. 2016;7(2):243–252.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Pilewskie ML, Morrow M. Management of the clinically node-negative axilla: what have we learned from the clinical trials? Oncology (Williston Park). 2014;28(5):371–378.

    PubMed  Google Scholar 

  16. Cserni G, Gregori D, Merletti F, et al. Meta-analysis of non-sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer. Br J Surg. 2004;91(10):1245–1252.

    Article  CAS  PubMed  Google Scholar 

  17. van Deurzen CH, de Boer M, Monninkhof EM, et al. Non-sentinel lymph node metastases associated with isolated breast cancer cells in the sentinel node. J Natl Cancer Inst. 2008;100(22):1574–1580.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Francissen CM, Dings PJ, van Dalen T, Strobbe LJ, van Laarhoven HW, de Wilt JH. Axillary recurrence after a tumor-positive sentinel lymph node biopsy without axillary treatment: a review of the literature. Ann Surg Oncol. 2012;19(13):4140–4149.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Karam I, Lesperance MF, Berrang T, Speers C, Tyldesley S, Truong PT. pN0(i+) breast cancer: treatment patterns, locoregional recurrence, and survival outcomes. Int J Radiat Oncol Biol Phys. 2013;87(4):731–737.

    Article  CAS  PubMed  Google Scholar 

  20. Rayhanabad J, Yegiyants S, Putchakayala K, Haig P, Romero L, Difronzo LA. Axillary recurrence is low in patients with breast cancer who do not undergo completion axillary lymph node dissection for micrometastases in sentinel lymph nodes. Am Surg. 2010;76(10):1088–1091.

    PubMed  Google Scholar 

  21. Pernas S, Gil M, Benitez A, et al. Avoiding axillary treatment in sentinel lymph node micrometastases of breast cancer: a prospective analysis of axillary or distant recurrence. Ann Surg Oncol. 2010;17(3):772–777.

    Article  PubMed  Google Scholar 

  22. Milgrom S, Cody H, Tan L, et al. Characteristics and outcomes of sentinel node-positive breast cancer patients after total mastectomy without axillary-specific treatment. Ann Surg Oncol. 2012;19(12):3762–3770.

    Article  PubMed  Google Scholar 

  23. Gradishar WJ, Anderson BO, Balassanian R, et al. Invasive Breast Cancer Version 1.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2016;14(3):324–354.

    Article  PubMed  Google Scholar 

  24. McGale P, Taylor C, Correa C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383(9935):2127–2135.

    Article  CAS  PubMed  Google Scholar 

  25. Anderson SJ, Wapnir I, Dignam JJ, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol. 2009;27(15):2466–2473.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Houvenaeghel G, Nos C, Mignotte H, et al. Micrometastases in sentinel lymph node in a multicentric study: predictive factors of nonsentinel lymph node involvement–Groupe des Chirurgiens de la Federation des Centres de Lutte Contre le Cancer. J Clin Oncol. 2006;24(12):1814–1822.

    Article  PubMed  Google Scholar 

  27. Louis-Sylvestre C, Clough K, Asselain B, et al. Axillary treatment in conservative management of operable breast cancer: dissection or radiotherapy? Results of a randomized study with 15 years of follow-up. J Clin Oncol. 2004;22(1):97–101.

    Article  PubMed  Google Scholar 

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Acknowledgement

The preparation of this study was funded in part by National Institutes of Health/National Cancer Center (NIH/NCI) Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center.

Disclosure

Anita Mamtani, Sujata Patil, Michelle Stempel, and Monica Morrow have no conflicts of interest to declare.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Anita Mamtani MD, Michelle Stempel MPH & Monica Morrow MD

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sujata Patil PhD

Authors
  1. Anita Mamtani MD
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  2. Sujata Patil PhD
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  3. Michelle Stempel MPH
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  4. Monica Morrow MD
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Corresponding author

Correspondence to Monica Morrow MD.

Additional information

This study was presented in oral format at the 70th Society of Surgical Oncology Annual Cancer Symposium, Seattle, WA, USA, 15–18 March 2017.

An erratum to this article is available at https://doi.org/10.1245/s10434-017-6004-2.

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Mamtani, A., Patil, S., Stempel, M. et al. Axillary Micrometastases and Isolated Tumor Cells Are Not an Indication for Post-mastectomy Radiotherapy in Stage 1 and 2 Breast Cancer. Ann Surg Oncol 24, 2182–2188 (2017). https://doi.org/10.1245/s10434-017-5866-7

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  • DOI: https://doi.org/10.1245/s10434-017-5866-7

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