Outcomes of Sentinel Lymph Node-Positive Breast Cancer Patients Treated with Mastectomy Without Axillary Therapy

Elizabeth FitzSullivan, Roland L. Bassett, Henry M. Kuerer, Elizabeth A. Mittendorf, Min Yi, Kelly K. Hunt, Gildy V. Babiera, Abigail S. Caudle, Dalliah M. Black, Isabelle Bedrosian, Chantal Reyna, Mediget Teshome, Funda Meric-Bernstam, Rosa Hwang

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Abstract

Purpose: Early-stage breast cancer patients with minimal axillary disease identified by sentinel lymph node dissection (SLND) have low regional recurrence rates when treated with breast-conserving surgery and radiation therapy (XRT) and many avoid a completion axillary lymph node dissection (CLND). As the incidence of total mastectomy (TM) has increased, it has become important to characterize which TM patients with a positive SLN may not benefit from further axillary treatment. Methods: An institutional database was utilized to identify patients treated with a TM for invasive breast cancer and who had a positive SLN from 1994 to 2010. Clinicopathologic factors were analyzed. Regional recurrence rate, recurrence-free survival (RFS), and overall survival (OS) were determined. Results: A total of 525 patients with invasive breast cancer and a positive SLN were treated with TM, including 58 patients who did not have CLND or XRT and 12 patients who did not have CLND but did receive XRT. Median follow-up was 66 months. The incidence of regional recurrence was not significantly different for patients who received no further axillary treatment compared to those who underwent CLND without XRT or those treated with XRT without CLND (10 years rate: 3.8 vs. 1.6 and 0 % respectively). RFS and OS were not significantly different among patients who received no further axillary treatment compared to those who underwent CLND, XRT, or both. Conclusions: In select patients with early-stage breast cancer treated with mastectomy with a positive SLN, CLND may be avoided without adversely affecting recurrence or survival.

Original languageEnglish (US)
Pages (from-to)652-659
Number of pages8
JournalAnnals of surgical oncology
Volume24
Issue number3
DOIs
StatePublished - Mar 1 2017

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Mastectomy
Lymph Node Excision
Breast Neoplasms
Simple Mastectomy
Recurrence
Survival
Therapeutics
Sentinel Lymph Node
Segmental Mastectomy
Incidence
Radiotherapy
Databases

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{ad8ea5349940441ab7f42185af9a88b1,
title = "Outcomes of Sentinel Lymph Node-Positive Breast Cancer Patients Treated with Mastectomy Without Axillary Therapy",
abstract = "Purpose: Early-stage breast cancer patients with minimal axillary disease identified by sentinel lymph node dissection (SLND) have low regional recurrence rates when treated with breast-conserving surgery and radiation therapy (XRT) and many avoid a completion axillary lymph node dissection (CLND). As the incidence of total mastectomy (TM) has increased, it has become important to characterize which TM patients with a positive SLN may not benefit from further axillary treatment. Methods: An institutional database was utilized to identify patients treated with a TM for invasive breast cancer and who had a positive SLN from 1994 to 2010. Clinicopathologic factors were analyzed. Regional recurrence rate, recurrence-free survival (RFS), and overall survival (OS) were determined. Results: A total of 525 patients with invasive breast cancer and a positive SLN were treated with TM, including 58 patients who did not have CLND or XRT and 12 patients who did not have CLND but did receive XRT. Median follow-up was 66 months. The incidence of regional recurrence was not significantly different for patients who received no further axillary treatment compared to those who underwent CLND without XRT or those treated with XRT without CLND (10 years rate: 3.8 vs. 1.6 and 0 {\%} respectively). RFS and OS were not significantly different among patients who received no further axillary treatment compared to those who underwent CLND, XRT, or both. Conclusions: In select patients with early-stage breast cancer treated with mastectomy with a positive SLN, CLND may be avoided without adversely affecting recurrence or survival.",
author = "Elizabeth FitzSullivan and Bassett, {Roland L.} and Kuerer, {Henry M.} and Mittendorf, {Elizabeth A.} and Min Yi and Hunt, {Kelly K.} and Babiera, {Gildy V.} and Caudle, {Abigail S.} and Black, {Dalliah M.} and Isabelle Bedrosian and Chantal Reyna and Mediget Teshome and Funda Meric-Bernstam and Rosa Hwang",
year = "2017",
month = "3",
day = "1",
doi = "10.1245/s10434-016-5605-5",
language = "English (US)",
volume = "24",
pages = "652--659",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",
number = "3",

}

TY - JOUR

T1 - Outcomes of Sentinel Lymph Node-Positive Breast Cancer Patients Treated with Mastectomy Without Axillary Therapy

AU - FitzSullivan, Elizabeth

AU - Bassett, Roland L.

AU - Kuerer, Henry M.

AU - Mittendorf, Elizabeth A.

AU - Yi, Min

AU - Hunt, Kelly K.

AU - Babiera, Gildy V.

AU - Caudle, Abigail S.

AU - Black, Dalliah M.

AU - Bedrosian, Isabelle

AU - Reyna, Chantal

AU - Teshome, Mediget

AU - Meric-Bernstam, Funda

AU - Hwang, Rosa

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Purpose: Early-stage breast cancer patients with minimal axillary disease identified by sentinel lymph node dissection (SLND) have low regional recurrence rates when treated with breast-conserving surgery and radiation therapy (XRT) and many avoid a completion axillary lymph node dissection (CLND). As the incidence of total mastectomy (TM) has increased, it has become important to characterize which TM patients with a positive SLN may not benefit from further axillary treatment. Methods: An institutional database was utilized to identify patients treated with a TM for invasive breast cancer and who had a positive SLN from 1994 to 2010. Clinicopathologic factors were analyzed. Regional recurrence rate, recurrence-free survival (RFS), and overall survival (OS) were determined. Results: A total of 525 patients with invasive breast cancer and a positive SLN were treated with TM, including 58 patients who did not have CLND or XRT and 12 patients who did not have CLND but did receive XRT. Median follow-up was 66 months. The incidence of regional recurrence was not significantly different for patients who received no further axillary treatment compared to those who underwent CLND without XRT or those treated with XRT without CLND (10 years rate: 3.8 vs. 1.6 and 0 % respectively). RFS and OS were not significantly different among patients who received no further axillary treatment compared to those who underwent CLND, XRT, or both. Conclusions: In select patients with early-stage breast cancer treated with mastectomy with a positive SLN, CLND may be avoided without adversely affecting recurrence or survival.

AB - Purpose: Early-stage breast cancer patients with minimal axillary disease identified by sentinel lymph node dissection (SLND) have low regional recurrence rates when treated with breast-conserving surgery and radiation therapy (XRT) and many avoid a completion axillary lymph node dissection (CLND). As the incidence of total mastectomy (TM) has increased, it has become important to characterize which TM patients with a positive SLN may not benefit from further axillary treatment. Methods: An institutional database was utilized to identify patients treated with a TM for invasive breast cancer and who had a positive SLN from 1994 to 2010. Clinicopathologic factors were analyzed. Regional recurrence rate, recurrence-free survival (RFS), and overall survival (OS) were determined. Results: A total of 525 patients with invasive breast cancer and a positive SLN were treated with TM, including 58 patients who did not have CLND or XRT and 12 patients who did not have CLND but did receive XRT. Median follow-up was 66 months. The incidence of regional recurrence was not significantly different for patients who received no further axillary treatment compared to those who underwent CLND without XRT or those treated with XRT without CLND (10 years rate: 3.8 vs. 1.6 and 0 % respectively). RFS and OS were not significantly different among patients who received no further axillary treatment compared to those who underwent CLND, XRT, or both. Conclusions: In select patients with early-stage breast cancer treated with mastectomy with a positive SLN, CLND may be avoided without adversely affecting recurrence or survival.

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U2 - 10.1245/s10434-016-5605-5

DO - 10.1245/s10434-016-5605-5

M3 - Article

C2 - 27822630

AN - SCOPUS:84994403149

VL - 24

SP - 652

EP - 659

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 3

ER -