Axillary recurrence after neoadjuvant chemotherapy: a retrospective study
Keywords:
axilla, breast neoplasms, data analysis, lymph node excision, neoadjuvant therapyAbstract
Introduction: The justification for this study emerged from the need to evaluate the performance of axillary lymphadenectomy in patients with positive sentinel lymph nodes who underwent neoadjuvant chemotherapy. Axillary lymph node dissection is an invasive and potentially morbid procedure designed to achieve complete remission of breast cancer and prevent unnecessary radical surgery. With the omission of the axillary lymphadenectomy, surgical complications are avoided including lymphedema, stress is decreased, and the quality of life improves in these patients. This study aimed to evaluate axillary recurrence in breast cancer patients undergoing neoadjuvant chemotherapy after the omission of radical axillary lymph node dissection in patients with positive sentinel lymph nodes. Methods: A retrospective study was conducted with ten patients from a clinic specializing in cancer diagnosis and treatment in Teresina (PI), Brazil, diagnosed with breast cancer from January 1998 to February 2021. These patients had positive sentinel lymph nodes and did not undergo axillary node dissection after neoadjuvant chemotherapy. Results: The median patient age at diagnosis was 52 years. All of them had clinical axillary involvement and received neoadjuvant chemotherapy regimen with doxorubicin, cyclophosphamide, and paclitaxel. In addition, they all received adjuvant radiotherapy in the postoperative period and the mean number of sentinel lymph nodes (SLN) removed was two. At a median follow-up of 39.5 months, there was no axillary recurrence and 90% of the patients were alive. Conclusions: At a median follow-up of 39.5 months none of the patients presented axillary recurrence.
Downloads
References
Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569-75. https://doi.org/10.1001/jama.2011.90
Giuliano AE, Ballman KV, McCall L, Beitsch PD, Brennan MB, Kelemen PR, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA. 2017;318(10):918-26. https://doi.org/10.1001/jama.2017.11470
Giuliano AE, Ballman K, McCall L, Beitsch P, Whitworth PW, Blumencranz P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the american college of surgeons oncology group (Alliance) ACOSOG Z0011 randomized trial. Ann Surg. 2016;264(3):413-20. https://doi.org/10.1097/SLA.0000000000001863
Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303-10. https://doi.org/10.1016/S1470-2045(14)70460-7
Classe JM, Bordes V, Campion L, Mignotte H, Dravet F, Leveque J, et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy for advanced breast cancer: results of Ganglion Sentinelle et Chimiotherapie Neoadjuvante, a French prospective multicentric study. J Clin Oncol. 2009;27(5):726-32. https://doi.org/10.1200/JCO.2008.18.3228
Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14(7):609-18. https://doi.org/10.1016/S1470-2045(13)70166-9
Caudle AS, Yang WT, Krishnamurthy S, Mittendorf EA, Black DM, Gilcrease MZ, et al. Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection. J Clin Oncol. 2016;34(10):1072-8. https://doi.org/10.1200/JCO.2015.64.0094
Almahariq MF, Levitin R, Quinn TJ, Chen PY, Dekhne N, Kiran S, et al. Omission of axillary lymph node dissection is associated with inferior survival in breast cancer patients with residual N1 nodal disease following neoadjuvant chemotherapy. Ann Surg Oncol. 2021;28(2):930-40. https://doi.org/10.1245/s10434-020-08928-2
Frasson AL, Resende HM, Lichtenfels M, Barbosa F, Souza ABA, Miranda I, et al. Axillary management for patients with breast cancer after neoadjuvant chemotherapy: results of a survey among Brazilian breast surgeons. J Surg Oncol. 2020;122(6):1247-51. https://doi.org/10.1002/jso.26104
Simons JM, Maaskant-Braat AJG, Luiten EJT, Leidenius MHK, van Nijnatten TJA, Boelens PG, et al. Patterns of axillary staging and management in clinically node positive breast cancer patients treated with neoadjuvant systemic therapy: Results of a survey amongst breast cancer specialists. Eur J Surg Oncol. 2020;46(1):53-8. https://doi.org/10.1016/j.ejso.2019.08.012
Ling DC, Iarrobino NA, Champ CE, Soran A, Beriwal S. Regional recurrence rates with or without complete axillary dissection for breast cancer patients with node-positive disease on sentinel lymph node biopsy after neoadjuvant chemotherapy. Adv Radiat Oncol. 2019;5(2):163-70. https://doi.org/10.1016/j.adro.2019.09.006
Najim O, Dockx Y, Huyghe I, van den Wyngaert T, Papadimitriou K, Tjalma WAA, et al. The predictive value of sentinel node biopsy in early breast cancer after neo-adjuvant chemotherapy: A prospective study. Eur J Obstet Gynecol Reprod Biol. 2018;229:108-11. https://doi.org/10.1016/j.ejogrb.2018.06.040
Zetterlund LH, Frisell J, Zouzos A, Axelsson R, Hatschek T, Boniface J, et al. Swedish prospective multicenter trial evaluating sentinel lymph node biopsy after neoadjuvant systemic therapy in clinically node-positive breast cancer. Breast Cancer Res Treat. 2017;163(1):103-10. https://doi.org/10.1007/s10549-017-4164-1
Boileau JF, Poirier B, Basik M, Holloway CM, Gaboury L, Sideris L, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol. 2015;33(3):258-64. https://doi.org/10.1200/JCO.2014.55.7827
van der Noordaa MEM, van Duijnhoven FH, Cuijpers FNE, van Werkhoven E, Wiersma TG, Elkhuizen PHM, et al. Toward omitting sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with clinically node-negative breast cancer. Br J Surg. 2021;108(6):667-74. https://doi.org/10.1002/bjs.12026
Chun JW, Kim J, Chung IY, Ko BS, Kim HJ, Lee JW, et al. Sentinel node biopsy alone for breast cancer patients with residual nodal disease after neoadjuvant chemotherapy. Sci Rep. 2021;11(1):9056. https://doi.org/10.1038/s41598-021-88442-x
Angarita S, Ye L, Rünger D, Hadaya J, Baker JL, Dawson N, et al. Assessing the burden of nodal disease for breast cancer patients with clinically positive nodes: hope for more limited axillary surgery. Ann Surg Oncol. 2021;28(5):2609-18. https://doi.org/10.1245/s10434-020-09228-5
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Lillian Maria Fernandes de Castro, Marina Silva Camarço Lima, Rafael Everton Assunção Ribeiro da Costa , Thiago Pereira Diniz , Sabas Carlos Vieira
This work is licensed under a Creative Commons Attribution 4.0 International License.