Outcomes of Clinically Node-Negative Breast Cancer Without Axillary Dissection: Can Preserved Axilla Be Safely Treated with Radiation after a Positive Sentinel Node Biopsy?

Naoko Sanuki, Atsuya Takeda, Atsushi Amemiya, Toru Ofuchi, Masashi Ono, Haruki Ogata, Ryo Yamagami, Jun Hatayama, Takahisa Eriguchi, Etsuo Kunieda

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Purpose: We analyzed whether axillary nodal irradiation could control clinically node-negative disease, including those patients with a positive sentinel lymph node biopsy (SLNB), most of whom received regional nodal irradiation. We also evaluated toxicity profiles that resulted from nodal irradiation. Patients and Methods: From 1988 to 2011, 2107 patients with cT1-T2N0M0 breast cancer underwent breast conservation therapy in the absence of axillary dissection: nx group (n = 1548), without any axillary surgery; the sn- group (n = 518), with a negative SLNB; and sn+ group (n = 104), with a positive SLNB. Results: The median follow-up times were 88, 56, and 55 months for the nx, sn-, and sn+ groups, respectively. The nx group had more risk factors than did the other 2 groups in terms of age, grade, or T stage. Ninety-eight percent of the sn-group received only tangent irradiation, and 100% and 83% of the sn+ and nx group, respectively, received additional regional nodal irradiation. The 5-year cumulative incidences of axillary failure and regional nodal failure were 34, 3, and 0 (2.7%, 0.7%, and 0%; P =.02, log-rank test) and 57, 4, and 0 (4.4, 1%, and 0; P =.04), respectively. Overall survival rates in 5 years were 96.4%, 98.9%, and 97.6% (P =.03), respectively. Symptomatic but transient radiation pneumonitis developed in 31, 16, and 6 (2.0%, 3.1%, and 5.7%). Mild arm edema was observed in 1, 4, and 0 (0.06%, 0.8%, and 0%) in the nx, sn-, sn+ groups, respectively. Conclusions: Treatment without axillary dissection showed excellent outcomes with negligible toxicity for patients with clinically node negative, including those with a positive SLNB. Regional nodal irradiation after a positive SLNB is a reasonable alternative to axillary dissection.

Original languageEnglish
Pages (from-to)69-76
Number of pages8
JournalClinical Breast Cancer
Volume13
Issue number1
DOIs
Publication statusPublished - 2013 Feb

Keywords

  • Axillary dissection
  • Axillary radiotherapy
  • Breast cancer
  • Regional node irradiation
  • Sentinel lymph node biopsy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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