Patients with Breast Cancer That Converts from Lymph Node-Positive to -Negative Can Skip Adjuvant Regional Nodal Irradiation

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The omission of adjuvant regional nodal irradiation did not appear to increase the risk for recurrence or death among patients with breast cancer whose disease converted from lymph node-positive to lymph node-negative after neoadjuvant chemotherapy, according to research presented at the 2023 San Antonio Breast Cancer Symposium
  • There is no standard of care in place for patients with breast cancer for whom neoadjuvant chemotherapy has eliminated lymph node involvement, the researchers explained
  • The researchers performed a phase 3 clinical trial of 1,641 patients with lymph-node positive, nonmetastatic breast cancer who were found to have no lymph node involvement after neoadjuvant chemotherapy and surgery
  • They randomly assigned patients to two different regimens:
    • One group was assigned to skip regional nodal irradiation after undergoing mastectomy or whole breast irradiation and breast-conserving surgery
    • The other group was assigned to continue with chest wall irradiation and regional nodal irradiation following mastectomy or whole-breast irradiation plus regional nodal irradiation and breast-conserving surgery
  • Median follow-up was 59.5 months, and patients were a median of 52 years old
  • Seventy-eight percent had experienced a complete breast pathological response
  • In the “no regional nodal irradiation group,” 91.8% of patients were invasive breast cancer-recurrence free at 5 years compared with 92.7% of those who did undergo regional nodal irradiation
  • In both groups, 93.4% of patients were reported to be distant-recurrence free at 5 years
  • Overall survival was 94% in patients who were assigned to skip regional nodal irradiation and 93.6% in those who did not skip the therapy, according to the researchers
  • The researchers are planning a longer-term follow-up to further examine their findings, and a 10-year analysis time point was reached this past year
  • There findings suggest that downstaging cancer-positive regional lymph nodes with neoadjuvant chemotherapy can allow some patients to skip adjuvant regional nodal irradiation without adversely affecting oncologic outcomes
    • Follow-up of patients for long-term outcomes continues
  • Reference: 
    • Mamounas, E. Loco-regional irradiation in patients with biopsy-proven axillary node involvement at presentation who become pathologically node-negative after neoadjuvant chemotherapy: Primary outcomes of NRG Oncology/NSABP B-51/RTOG 1304. Abstract GS02-07. SABCS 2023
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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