Characteristics and Outcomes of Sentinel Node–Positive Breast Cancer Patients after Total Mastectomy without Axillary-Specific Treatment

Milgrom, Sarah A.; Cody, Hiram S.; Tan, Lee K.; Morrow, Monica; Pesce, Catherine; Setton, J.; Rogers, Katherine H.; Arnold, Brittany; Eaton, Anne; Catalano, Jeffrey P.; McCormick, Beryl; Powell, Simon N.; Ho, Alice Y.

doi:10.1245/s10434-012-2386-3

Cited by 63 publications

(29 citation statements)

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“…18 Smaller studies also including patients treated with both mastectomy and breast conservation with varying radiotherapy approaches have also reported axillary recurrence rates of less than 3% among patients with nodal micrometastases. 1,19–22 To our knowledge, our study is the first validation of these favorable results in a large contemporary cohort of patients with T1–T2N0i+/N1mi disease treated with mastectomy and without PMRT.…”

Section: Discussionmentioning

confidence: 55%

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

et al. 2017

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Background Randomized trials demonstrate equivalent locoregional control with sentinel node biopsy (SLNB) or axillary 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 (N0i+/N1mi) having mastectomy. Methods We identified patients with T1–2N0i+/N1mi breast cancer treated with mastectomy from 1/2006–12/2011. Recurrent, bilateral, and neoadjuvant cases were excluded. The primary outcome of interest was LRR. Results 352 patients, 211 (60%) with ITCs and 141 (40%) with micrometastases, were identified. 162 (46%) had SLNB alone and 1 node was positive in 295 (84%) cases. 31 (9%) had PMRT. 95% had systemic therapy. At median 6 years 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 median age 55yrs, median tumor size 1.7cm, and ductal histology; the majority were high-grade (89%), estrogen receptor positive (78%), with 1 positive node (89%). There was no association between LRR and receipt of PMRT (p=0.4), SNB vs ALND (p=0.2), or number of positive nodes (p=0.7) by 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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Section: Discussionmentioning

confidence: 55%

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

et al. 2017

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“…A previously discussed MSKCC paper focused on total mastectomy patients (n = 210) with positive SLNB who did not receive axillary-specific treatment [62,63]. Characteristics and outcomes were compared to similar patients who underwent BCS (n = 325).…”

Section: Involved Sentinel Lymph Nodes and Mastectomymentioning

confidence: 99%

Local Treatment of the Axilla in Early Breast Cancer: Concepts from the National Surgical Adjuvant Breast and Bowel Project B-04 to the Planned Intergroup Sentinel Mamma Trial

et al. 2014

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Local treatment of the axilla in clinically node-negative, early-stage breast cancer patients has been hotly debated after the release of the American College of Surgeons Oncology Group (ACOSOG) Z0011 findings. However, this review does not focus on the ‘Z0011-eligible' patients alone, because this subgroup represents a minority of our patients undergoing breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB). The following topics are discussed: axillary diagnostics, timing of axillary procedures in the neoadjuvant setting, long-term follow-up of SLNB trials, omission of axillary surgery in randomized trials, management of the involved axilla with low tumor volume, positive sentinel lymph nodes and BCS, involved sentinel lymph nodes and mastectomy, and axillary radiotherapy. Finally, the current innovative study concepts (i.e. Sentinel Node versus Observation after Axillary Ultrasound (SOUND) and Intergroup Sentinel Mamma (INSEMA)) including patients with axillary observation alone in clinically node-negative women are presented.

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“…Therefore, it is unclear whether ALND is necessary for all node-positive breast cancers. Several retrospective studies where ALND was omitted after detecting micro-or macrometastases in the SLN showed very low rates of axillary recurrence 27–29. Two prospective randomized trials confirmed these results for micrometastases and up to two macrometastases.…”

Section: The Role Of Lymph Node Mapping In Cancer Managementmentioning

confidence: 89%

Mapping lymph nodes in cancer management – role of 99mTc-tilmanocept injection

Tausch¹,

Baege²,

Rageth³

2014

OTT

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Two decades ago, lymphatic mapping of sentinel lymph nodes (SLN) was introduced into surgical cancer management and was termed sentinel node navigated surgery. Although this technique is now routinely performed in the management of breast cancer and malignant melanoma, it is still under investigation for use in other cancers. The radioisotope technetium (99mTc) and vital blue dyes are among the most widely used enhancers for SLN mapping, although near-infrared fluorescence imaging of indocyanine green is also becoming more commonly used. 99mTc-tilmanocept is a new synthetic radioisotope with a relatively small molecular size that was specifically developed for lymphatic mapping. Because of its small size, 99mTc-tilmanocept quickly migrates from its site of injection and rapidly accumulates in the SLN. The mannose moieties of 99mTc-tilmanosept facilitate its binding to mannose receptors (CD206) expressed in reticuloendothelial cells of the SLN. This binding prevents transit to second-echelon lymph nodes. In Phase III trials of breast cancer and malignant melanoma, and Phase II trials of other malignancies, 99mTc-tilmanocept had superior identification rates and sensitivity compared with blue dye. Trials comparing 99mTc-tilmanocept with other 99mTc-based agents are required before it can be routinely used in clinical settings.

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Characteristics and Outcomes of Sentinel Node–Positive Breast Cancer Patients after Total Mastectomy without Axillary-Specific Treatment

Abstract: Early-stage breast cancer patients with minimal sentinel node disease experience excellent outcomes without ALND, whether they undergo BCS or TM.

Cited by 63 publications

References 18 publications

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

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

Local Treatment of the Axilla in Early Breast Cancer: Concepts from the National Surgical Adjuvant Breast and Bowel Project B-04 to the Planned Intergroup Sentinel Mamma Trial

Mapping lymph nodes in cancer management – role of 99mTc-tilmanocept injection

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Characteristics and Outcomes of Sentinel Node–Positive Breast Cancer Patients after Total Mastectomy without Axillary-Specific Treatment

Abstract: Early-stage breast cancer patients with minimal sentinel node disease experience excellent outcomes without ALND, whether they undergo BCS or TM.

Cited by 63 publications

References 18 publications

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

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

Local Treatment of the Axilla in Early Breast Cancer: Concepts from the National Surgical Adjuvant Breast and Bowel Project B-04 to the Planned Intergroup Sentinel Mamma Trial

Mapping lymph nodes in cancer management &ndash; role of 99mTc-tilmanocept injection

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Mapping lymph nodes in cancer management – role of 99mTc-tilmanocept injection