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Open Access 02-05-2022 | Breast Cancer | Original Article

Whole breast radiotherapy in cN0 early breast cancer patients with pathological sentinel lymph nodes (pN1mic, pN1a) without axillary dissection: preliminary results of the observational LISEN trial

Authors: Lucia Anna Ursini, Marianna Nuzzo, Dr. Consuelo Rosa, Marzia Borgia, Luciana Caravatta, Monica Di Tommaso, Marianna Trignani, Fiorella Cristina Di Guglielmo, Giampiero Ausili Cefaro, Domenico Angelucci, Marzia Muzi, Gianluigi Martino, Ettore Cianchetti, Simona Grossi, Saveria Tavoletta, Davide Brocco, Antonino Grassadonia, Nicola Tinari, Simona Gildetti, Nicola D’Ostilio, Liborio Stuppia, Annamaria Porreca, Marta Di Nicola, Domenico Genovesi

Published in: Strahlentherapie und Onkologie | Issue 7/2022

Abstract

Purpose

Axillary management remains unclear when sentinel lymph node (SLN) results are positive in cN0 patients with breast cancer (BC). The trial ACOSOG Z0011 represented a revolution with axillary lymph node dissection (ALND) omission in SLN+ patients, despite critiques regarding non-uniformity of radiation fields. We conducted an observational study (LISEN) where whole breast radiotherapy (WBRT) was planned with tangential fields without nodal irradiation in patients eligible for the Z0011 trial.

Methods

Inclusion criteria were female patients with histologically proven BC, cT1-2cN0, planned conservative surgery, no neoadjuvant therapy. Patients were stratified into two groups: micrometastatic (pN1mic, group 1) and macrometastatic (pN1a, group 2) lymph nodes. Tangential field WBRT was mandatory. Clinical outcomes were analysed, measured from surgery until the first event.

Results

In all, 199 patients underwent conservative surgery and SLN biopsy; 133 patients meeting criteria were analysed: 41 patients (30.8%) pN1mic and 92 (69.2%) pN1a. The 5‑year disease-free survival (DFS) was 95.0% (85.9–100%) in group 1 and 93.0% (86.3–100.0%) in group 2 (p = 0.78). Overall survival (OS) was 100% (100–100%) in group 1 and 97.4% (92.4–100%) in group 2 (p = 0.74). For the whole cohort DFS and OS were 93.6% (88.2–99.4%) and 96.9% (91.5–100.0%), respectively. For groups 1 and 2, the 5‑year outcomes were 5.0% (0.0–14.4%) and 2.3% (0.0–6.1%) for local recurrence (p = 0.51), and 6.2% (0.0–17.4%) and 7.0% (0.0–13.7%) for distant metastasis (p = 0.61), respectively. In group 1, regional recurrence (RR) and local regional recurrence (LRR) were 5.0% (0.0–14.1%; p = 0.13). In group 2, RR and LRR were 0.0% (0.0–0.0%).

Conclusion

Our results showed good regional control in patients who met the Z0011 trial criteria. WBRT, without nodal surgery or RT, avoiding axillary morbidity, seems to be a good choice.

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Title: Whole breast radiotherapy in cN0 early breast cancer patients with pathological sentinel lymph nodes (pN1mic, pN1a) without axillary dissection: preliminary results of the observational LISEN trial
Authors: Lucia Anna Ursini
Marianna Nuzzo
Dr. Consuelo Rosa
Marzia Borgia
Luciana Caravatta
Monica Di Tommaso
Marianna Trignani
Fiorella Cristina Di Guglielmo
Giampiero Ausili Cefaro
Domenico Angelucci
Marzia Muzi
Gianluigi Martino
Ettore Cianchetti
Simona Grossi
Saveria Tavoletta
Davide Brocco
Antonino Grassadonia
Nicola Tinari
Simona Gildetti
Nicola D’Ostilio
Liborio Stuppia
Annamaria Porreca
Marta Di Nicola
Domenico Genovesi
Publication date: 02-05-2022
Publisher: Springer Berlin Heidelberg
Keywords: Breast Cancer
Breast Cancer
Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 7/2022
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-022-01944-z

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Whole breast radiotherapy in cN0 early breast cancer patients with pathological sentinel lymph nodes (pN1mic, pN1a) without axillary dissection: preliminary results of the observational LISEN trial

Abstract

Purpose

Methods

Results

Conclusion

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Abstract

Purpose

Methods

Results

Conclusion

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