Home Medizin Knotenstrahlung kann eine BC-Achseldissektion unnötig machen

Knotenstrahlung kann eine BC-Achseldissektion unnötig machen

von NFI Redaktion

AB SABCS 2023

According to a large Scandinavian study presented at the San Antonio Breast Cancer Symposium, axillary lymph node dissection may be unnecessary in breast cancer patients with one or two positive sentinel lymph nodes planning for adjuvant lymph node radiation.

„This means that you don’t need to prepare the armpit if you plan to radiate the armpit.“ „For the United States, this is the conclusion, because there are still centers that do both, and that is excluded,“ said lead researcher Dr. Jana de Boniface, a breast cancer surgeon at the Karolinska Institutet in Stockholm, in an interview.

The study complemented an ongoing theme of this year’s conference: protecting breast cancer patients from over-treatment and unnecessary harm. Some even questioned the necessity of a 5-year endocrine therapy.

Dr. Bonifatius shared her thoughts after presenting the Scandinavian SENOMAC trial that she led.

SENOMAC randomized 1204 patients with one or two positive sentinel lymph nodes to an axillary dissection; 1335 with the same findings were randomized to no dissection.

The subjects had clinically primary breast cancer T1-3 N0. Approximately 89% in both arms received adjuvant radiation, including node radiation, and almost all continued with systemic therapy, which included endocrine therapy in over 90%. Only about 2% of subjects received neoadjuvant therapy.

With a median follow-up of almost 4 years, recurrence-free survival in both groups was practically identical, with 8% of patients in the dissection arm and 7.1% in the no-dissection group experiencing recurrences. The estimated 5-year recurrence-free survival was just under 90% in both groups. Skipping a dissection was not inferior to such (P < .001).

SENOMAC „clearly shows that you don’t need to prepare the armpit if you have one to two positive sentinel lymph nodes,“ as long as patients receive adjuvant lymph node radiation. The recurrence-free survival curves „practically overlap and we can’t see any difference between the two groups,“ said Dr. Boniface.

Meanwhile, the dissection group fared worse in patient-reported outcomes. Overall survival results, the primary endpoint of the study, are expected within two years.

The goal of the largest process on this topic to date was to fill gaps in the literature. Similar results were reported about a decade ago in patients with low burden sentinel lymph nodes, but extensive exclusion criteria raised questions about generalizability.

In contrast, SENOMAC was largely inclusive. Over a third of patients had mastectomies, over a third had extracapsular sentinel lymph node extension, almost 6% had T3 disease, almost 20% had lobular carcinoma, 40% were 65 years or older, and tumors were up to 15.5 cm in size.

The results held true regardless of these and other subgroup analysis factors, including estrogen receptor and HER2 status and the number of additional positive nodes identified in the dissection group.

Andrea V. Barrio, MD, a study discussant and breast cancer surgeon at the Memorial Sloan Kettering Cancer Center, New York, agreed with the message of SENOMAC.

„Based on this, ALND [axillary lymph node dissection] should not be considered a standard in patients with clinical T1-3-N0 breast cancer with one to two positive sentinel lymph nodes, with or without microscopic extracapsular extension, undergoing lumpectomy or mastectomy, as long as nodal adjuvant radiotherapy is indicated,“ she said.

Although adjuvant lymph node radiation is standard practice for patients with one to three positive sentinel lymph nodes in Denmark and Sweden, where most patients in SENOMAC were located, practices in the United States are very different. If adjuvant radiation is not used, then ALND [is still] indicated,“ said Dr. Barrio, but in both cases „only one is necessary.“

In line with the de-escalation theme of the 2023 symposium, both Drs.

In SENOMAC, preoperative axillary ultrasound was mandatory, and patients with nonpalpable, suspicious axillary lymph nodes were included.

36 were positive on fine needle aspiration and were randomized to the study, but when Dr. Boniface was asked, he did not have immediate data on how they fared.

The work was funded by the Swedish Research Council, the Nordic Cancer Union, and others. Bonifatius and Dr. Barrio did not disclose.

This article originally appeared on MDedge.com part of the Medscape Professional Network.

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