Considerations in the Locoregional Treatment of Patients With Early-Stage Breast Cancer
Posted: Monday, November 2, 2020
Many patients with early-stage breast cancer may not require aggressive surgical and radiotherapeutic approaches, with more conservative strategies often yielding comparable outcomes. During the NCCN 2020 Virtual Annual Conference, highlights of which were published in JNCCN–Journal of the National Comprehensive Cancer Network, Benjamin O. Anderson, MD, of the University of Washington and the Fred Hutchinson Cancer Research Center, Seattle, and Janice A. Lyons, MD, of Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center, Cleveland, focused on some of the issues facing clinicians in the treatment of this patient population. With more neoadjuvant therapy being used, they discussed the nuances in locoregional management that clinicians should now appreciate, specifically in terms of complete axillary lymph node dissection and axillary radiotherapy.
Complete axillary lymph node dissection comes at a “significant cost,” Dr. Anderson commented, in terms of the potential for the lifelong problem with lymphedema. Thus, for patients with clinically node-negative disease at diagnosis, with at most one or two suspicious nodes on imaging, sentinel lymph node biopsy alone may be acceptable. “We now have excellent evidence that when we only see micrometastases in the sentinel node, we have adequate justification for no further axillary surgery,” Dr. Anderson stated.
In terms of radiation therapy, patients with T1 or T2, clinically node-negative disease, who undergo either breast-conserving therapy or mastectomy, may be adequately treated with axillary radiotherapy instead of axillary lymph node dissection. According to Dr. Lyons, considerations for radiotherapy begin with the question of nodal involvement, and then treatment should be planned accordingly. “Thinking through the way we treat patients with node-positive disease,” she commented, “we must first ask how much we think the lymph node regions are at risk and whether systemic therapy may be sufficient so that we are not required to treat extensive fields.”
Disclosure: Dr. Anderson has received consulting fees from Allergan and has served as a scientific advisor to UE LifeSciences. Dr. Lyons reported no conflicts of interest.