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Abstract
Introduction. Studies have shown the possibility of safely reducing the extent of surgical intervention for patients with early-stage breast cancer. Another potential approach for de-escalating locoregional therapy in this population is the safe omission of radiotherapy to the supraclavicular and level III axillary lymph nodes.
Aim. To evaluate the efficacy and safety of omitting radiotherapy to the supraclavicular and level III axillary lymph nodes in patients with early breast cancer who achieve a complete pathological response (pCR) to neoadjuvant systemic therapy (NAST).
Materials and Methods. The interim analysis included 42 patients with early breast cancer. All patients had a pCR following NAST. A course of external beam radiation therapy commenced 6–12 weeks post-surgery, administered concurrently with targeted or hormonal therapy. Radiation was delivered in 16 fractions of 2.66 Gy (n=29) or 5 fractions of 5.2 Gy (n=13). The clinical target volume comprised the remaining breast tissue and level I/II axillary lymph nodes (including interpectoral and subpectoral nodes). Locoregional recurrence-free survival at 3 years was analyzed using the Kaplan-Meier method.
Results. The median follow-up in the interim analysis was 36 months (range 21–58). The 3-year locoregional control and recurrence-free survival in the ipsilateral supraclavicular area were 100%. The 3-year relapse-free survival (RFS) was 97.6%. One patient with a luminal B subtype experienced dissemination during the second year of follow-up.
Conclusion. This interim analysis suggests that in patients with early breast cancer who achieve pCR after NAST, omission of radiotherapy to the supraclavicular and level III axillary lymph nodes, over a median 3-year follow-up, does not compromise 3-year RFS rates or increase the risk of recurrence in the supraclavicular region.
References
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