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

被引:58
作者
Wernicke, A. Gabriella [1 ]
Goodman, Robert L. [2 ]
Turner, Bruce C. [3 ]
Komarnicky, Lydia T. [4 ]
Curran, Walter J. [5 ]
Christos, Paul J. [6 ]
Khan, Imraan [7 ]
Vandris, Katherine [8 ]
Parashar, Bhupesh [1 ]
Nori, Dattatreyudu [1 ]
Chao, K. S. Clifford [1 ]
机构
[1] Cornell Univ, Weil Cornell Med Coll, Dept Radiat Oncol, New York, NY 10065 USA
[2] St Barnabas Hosp, Dept Radiat Oncol, Livingston, NJ USA
[3] Thomas Jefferson Univ Hosp, Dept Radiat Oncol, Philadelphia, PA 19107 USA
[4] Drexel Univ Hosp, Dept Radiat Oncol, Philadelphia, PA USA
[5] Emory Univ, Sch Med, Dept Radiat Oncol, Atlanta, GA USA
[6] Cornell Univ, Weill Cornell Med Coll, Dept Publ Hlth, Div Biostat & Epidemiol, New York, NY 10021 USA
[7] SUNY Stony Brook, Dept Biol Sci, Stony Brook, NY 11794 USA
[8] Cornell Univ, Weill Cornell Med Coll, Dept Med, Div Hematol Med Oncol, New York, NY 10021 USA
关键词
Sentinel lymph node sampling; Axillary lymph node dissection; Breast cancer; Tangential breast radiotherapy; Radiotherapy; SURGICAL ADJUVANT BREAST; NSABP B-32 TRIAL; RADIATION-THERAPY; AMERICAN-COLLEGE; TOTAL MASTECTOMY; LEVEL-I; BIOPSY; FIELDS; CARCINOMA; RESECTION;
D O I
10.1007/s10549-010-1167-6
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
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.
引用
收藏
页码:893 / 902
页数:10
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