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- Title
Favoral Local Control in Patients with Breast Cancer Following SLNB without Axillary Dissection after Neoadjuvant Chemotherapy: Multicentric MF-18-02-Study.
- Authors
Cabioğlu, Neslihan; Karanlık, Hasan; Yıldırım, Nilüfer; Çakmak, Güldeniz Karadeniz; Müslümanoğlu, Mahmut; Uras, Cihan; Yeniay, Levent; Tükenmez, Mustafa; Emiroğlu, Selman; Özkurt, Enver; Kara, Halil; Özmen, Vahit; İgci, Abdullah
- Abstract
Objective: Omitting axilary lymph node dissection (ALND) following SLNB with residual cancer in patients with locally advanced disease after neoadjuvan chemotherapy (NAC) is still controversial. In this study, we evaluated factors affecting local recurrence and outcome in patients with locally advanced breast cancer (LABC), who underwent sentinel lymph node (SLN) without ALND after NAC. Materials and Methods: Between 2003 to 2018, 265 patients with clinically node-positive LABC who received NAC and underwent SLNB without ALND were retrospectively analyzed. All patients had whole breast and/or regional nodal irradiation. All recurrences of axilla, peripheric lymphatic, and breast were accepted as locoregional recurrence. Results: Median age of patients was 45 (23-70). Of those, 191 patients (72%) were clinically T1-2, and 74 patients (28%) were clinically T3-4 before receiving NAC. Of those, whereas 220 patients were cN1 (83%), and 45 patients were cN2-3 (17%). The median number of SLNs removed was 3 (1-7), and the the median lymph node number retrieved was 4 (1-7). Of 265 patients, 184 patients (64%) were treated with breast conserving therapy (BCT), whereas the remaining underwent mastectomy. Of patients, 69% had negative SLNs, and the remaining 81 patients (31%) had positive SLNs (34 micrometastasis, 14 isolated tumor cells and 29 macrometastases), and the majority had (90%) no extracapsular lymph node invasion. At a median follow up time of 39 months (12-172), none of the patients developed an axillary recurrence. The ipsilateral breast cancer recurrence rate was found to be 4.1% among patients with BCT. Furthermore, one patient (0.4%) with macrometastatic SLNB including extracapsular invasion was found to have locoregional recurrence including thoracic wall and supraclavicular region metastasis. Fiveyear locoregional recurrence (LRR)-free, disease-free survival (DFS) and disease specific survival (DSS) rates were found as 95.1%, 88.5% and 94.2%, respectively. No difference could be found in 5-year LRR-free survival, DFS, and DSS rates between patients with a negative or positive SLNB (LRR-rate: SLNB-negative, 97% vs SLNB-positive, 90%, p=0.20; DSS: SLN(-): 96.5% vs SLNB(+): 94.2; p=0.37;DFS: SLN(-)90% vs SLN(+) 84.7; p=0.14). Conclusion: Our findings suggest ALND could be safely avoided in patients with LABC who underwent SLNB after receiving NAC in selected patients with good responders to NAC including patients with negative SLNs or low tumor burden such as micrometastasis/ITC or macrometastis without extracapsular extension esas long as axillary radiation therapy is provided.
- Subjects
BREAST cancer treatment; SENTINEL lymph node biopsy; LYMPHADENECTOMY; NEOADJUVANT chemotherapy; CHEMOTHERAPY complications; MASTECTOMY
- Publication
European Journal of Breast Health, 2019, Vol 15, pS24
- ISSN
2587-0831
- Publication type
Article