Postmastectomy and Regional Nodal Radiation for Breast Cancer

Torres, Mylin A.; Horst, Kathleen C.; Freedman, Gary M.

doi:10.1200/jco.19.02908

Cited by 7 publications

(5 citation statements)

References 62 publications

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“…All patients with pathologic involvement of the axilla received adjuvant whole breast/chest wall radiotherapy together with comprehensive regional nodal irradiation (RNI) according to published international guidelines[ 21 , 22 ].…”

Section: Methodsmentioning

confidence: 99%

Macrometastasis at selective lymph node biopsy: A practical going-for-the-one clinical scoring system to personalize decision making

Herrero¹,

Ciérvide²,

Calle-Purón³

et al. 2021

WJCO

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BACKGROUND Axillary sentinel lymph node biopsy (SLNB) is standard treatment for patients with clinically and pathological negative lymph nodes. However, the role of completion axillary lymph node dissection (cALND) following positive sentinel lymph node biopsy (SLNB) is debated. AIM To identify a subgroup of women with high axillary tumor burden undergoing SLNB in whom cALND can be safely omitted in order to reduce the risk of long-term complications and create a Preoperative Clinical Risk Index (PCRI) that helps us in our clinical practice to optimize the selection of these patients. METHODS Patients with positive SLNB who underwent a cALND were included in this study. Univariate and multivariate analysis of prognostic and predictive factors were used to create a PCRI for safely omitting cALND. RESULTS From May 2007 to April 2014, we performed 1140 SLN biopsies, of which 125 were positive for tumor and justified to practice a posterior cALND. Pathologic findings at SLNB were micrometastases (mic) in 29 cases (23.4%) and macrometastasis (MAC) in 95 cases (76.6%). On univariate analysis of the 95 patients with MAC, statistically significant factors included: age, grade, phenotype, histology, lymphovascular invasion, lymph-node tumor size, and number of positive SLN. On multivariate analysis, only lymph-node tumor size (≤ 20 mm) and number of positive SLN (> 1) retained significance. A numerical tool was created giving each of the parameters a value to predict preoperatively which patients would not benefit from cALND. Patients with a PCRI ≤ 15 has low probability (< 10%) of having additional lymph node involvement, a PRCI between 15-17.6 has a probability of 43%, and the probability increases to 69% in patients with a PCRI > 17.6. CONCLUSION The PCRI seems to be a useful tool to prospectively estimate the risk of nodal involvement after positive SLN and to identify those patients who could omit cALND. Further prospective studies are necessary to validate PCRI clinical generalization.

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Section: Methodsmentioning

confidence: 99%

Macrometastasis at selective lymph node biopsy: A practical going-for-the-one clinical scoring system to personalize decision making

Herrero¹,

Ciérvide²,

Calle-Purón³

et al. 2021

WJCO

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“…At the same time, owing to the early stages of breast mucinous adenocarcinoma, a considerable proportion of patients undergo breast-conserving surgery. Radiotherapy after breast-conserving surgery is a standard process [11][12][13][14], so the proportion of patients receiving it in this study was high.…”

Section: Introductionmentioning

confidence: 92%

Clinicopathological features and prognostic analysis of Her-2-negative breast mucinous adenocarcinoma: A SEER database analysis

Liu

et al. 2023

Preprint

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Background Breast mucinous adenocarcinoma is a group of malignant tumors of epithelial origin of the breast with a good prognosis; however, whether its treatment regimen should be consistent with that of non-specific types of breast cancer remains to be investigated. Methods In this study, the clinicopathological information, treatment modalities, and prognosis of 10,466 patients with mucinous adenocarcinoma of the breast from the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Results After adjusting for other factors, radiotherapy showed a favorable benefit in most subgroups; although this may be associated with a higher proportion of breast-conserving surgery in early cases, chemotherapy did not show any benefit. In particular, estrogen receptor-negative subgroup patients who received chemotherapy had a poorer prognosis. Conclusions Although derived from retrospective studies, the results of these analyses revealed trends that may warrant further study.

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“…Patients may be at risk of locoregional recurrence (LRR) after mastectomy due to microscopic residual disease areas in the chest wall and draining lymphatics. Post-mastectomy radiotherapy (PMRT) has been found to reduce LRR risk and potentially improve survival ( 18 ). Of note, Protons-PMRT provides excellent locoregional control rates and nearly complete avoidance of cardiopulmonary structures compared to photon-based approaches ( 19 ).…”

Section: Clinical Outcomes For Proton Therapymentioning

confidence: 99%

Particle Therapy for Breast Cancer: Benefits and Challenges

et al. 2021

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Hadron therapy with protons and carbon ions is widely attracting interest as a potential competitor of conventional photon radiotherapy. Exquisite dose distribution of charged particles allows for a higher local control of the tumor and lower probability of damage to nearby healthy tissues. Heavy ions have presumed biological advantages rising from their high-linear energy transfer (LET) characteristics, including greater cell-killing effectiveness and reduced heterogeneity dependence of radiation response. Although these advantages are clear and supported by data, only 18.0% of proton and carbon ion radiotherapy (CIRT) facilities in Europe are treating breast cancers. This review summarizes the physical and radiobiological properties of charged particles, clinical use of particle beam for breast cancer, and suggested approaches to overcome technical and financial challenges.

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Postmastectomy and Regional Nodal Radiation for Breast Cancer

Abstract: Author affiliations and support information (if applicable) appear at the end of this article.

Cited by 7 publications

References 62 publications

Macrometastasis at selective lymph node biopsy: A practical going-for-the-one clinical scoring system to personalize decision making

Macrometastasis at selective lymph node biopsy: A practical going-for-the-one clinical scoring system to personalize decision making

Clinicopathological features and prognostic analysis of Her-2-negative breast mucinous adenocarcinoma: A SEER database analysis

Particle Therapy for Breast Cancer: Benefits and Challenges

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