Advertisment

Groundbreaking Study Suggests Some Breast Cancer Patients May Skip Nodal Irradiation

author-image
Anthony Raphael
New Update
NULL

Groundbreaking Study Suggests Some Breast Cancer Patients May Skip Nodal Irradiation

Advertisment

A groundbreaking multicenter trial, presented at the 2023 San Antonio Breast Cancer Symposium, has brought to light significant findings that could change the treatment process for some breast cancer patients. The study, led by breast cancer surgeon Eleftherios Mamounas, showed that women whose positive axillary lymph nodes turned negative after neoadjuvant chemotherapy might not require regional nodal irradiation (RNI). This change could potentially avert unnecessary toxicity and complications.

Advertisment

The Trial and Its Findings

The trial involved 1556 women who were randomized to receive either regional nodal irradiation or no nodal irradiation post-surgery. The results observed no meaningful differences in outcomes between the two groups, with 5-year disease-free survival and overall survival being similar. Additionally, the trial did not observe study-related deaths or unexpected toxicities. Based on these outcomes, the study suggests that RNI can be omitted for women who fit the study criteria.

Details of Treatment Methods

Advertisment

The participants in the trial were randomly assigned in equal proportions to undergo chest wall irradiation plus RNI after mastectomy or whole breast irradiation plus RNI after breast-conserving surgery (RNI arm) or to observation after mastectomy or whole breast irradiation after breast-conserving surgery (no-RNI arm). The findings show that with neoadjuvant chemotherapy, adjuvant radiotherapy can be tailored based on the nodal response to the chemotherapy regimen.

Chemotherapy and Skipping RNI

Patients with breast cancer who underwent chemotherapy and skipped RNI did not face an increased risk of disease recurrence or death 5 years post-surgery. The trial showed similar outcomes between patients who received adjuvant RNI and those who did not. Approximately 91.8% of patients in the no RNI arm and 92.7% in the RNI arm were free of invasive breast cancer recurrences 5 years after undergoing surgery. The distant recurrence and overall survival rates were also similar between the 2 arms. This evidence suggests that downstaging cancer-positive regional lymph nodes with neoadjuvant chemotherapy can allow some patients to skip adjuvant RNI without adversely affecting oncologic outcomes.

Future Implications

The results of this study could potentially provide clarity in an ongoing debate about the optimal postsurgical treatment for patients who present with axillary node involvement, receive neoadjuvant chemotherapy, and are found to be pathologically node-negative at surgery. However, a potential limitation of the study is that patients have so far experienced fewer breast cancer recurrences than expected, which impacted the researchers’ ability to perform the planned statistical analyses based on the number of recurrences. This calls for a more extended follow-up to strengthen the analysis. The trial was funded by the National Cancer Institute, and the presenters disclosed their consulting and speaker engagements with pharmaceutical companies.

Advertisment
Chat with Dr. Medriva !