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. 2022 Oct;29(10):6267-6273.
doi: 10.1245/s10434-022-12193-w. Epub 2022 Jul 18.

How Often Do Sentinel Lymph Node Biopsy Results Affect Adjuvant Therapy Decisions Among Postmenopausal Women with Early-Stage HR+/HER2- Breast Cancer in the Post-RxPONDER Era?

Melissa Pilewskie  1   2 , Varadan Sevilimedu  3 , Idil Eroglu  4   5 , Tiana Le  4 , Rui Wang  6 , Monica Morrow  4 , Lior Z Braunstein  7
Affiliations

How Often Do Sentinel Lymph Node Biopsy Results Affect Adjuvant Therapy Decisions Among Postmenopausal Women with Early-Stage HR+/HER2- Breast Cancer in the Post-RxPONDER Era?

Melissa Pilewskie et al. Ann Surg Oncol. 2022 Oct.

Abstract

Background: The RxPONDER trial reported no benefit to chemotherapy among postmenopausal patients with HR+/HER2- tumors, one to three positive nodes, and low recurrence scores, questioning the role of axillary staging in this population. Here, we evaluate the impact of sentinel lymph node biopsy (SLNB) results on adjuvant therapy decisions in postmenopausal women with HR+/HER2- breast cancer.

Patients and methods: Postmenopausal women with cT1-2N0, HR+/HER2- breast cancer treated with lumpectomy and SLNB from 2012 to 2018 were identified. Receipt of nodal irradiation, indication for axillary lymph node dissection (ALND) and chemotherapy, and partial breast irradiation (PBI) eligibility were reviewed with pre- and post-SLNB results.

Results: A total of 1786 women were identified: median age 62 years, 84% with pT1 tumors, and 16% with pT2-3 tumors. Of those, 85% (n = 1525) remained pN0, 14% (n = 244) were pN1, and 1% (n = 17) were pN2-3. A total of 20 (1%) patients had > 2 positive SLNs, necessitating ALND. Pre-SLNB, 1478 women were considered PBI eligible; post-SLNB, 227 (13%) converted to PBI ineligible. In total, 58 patients with positive nodes received nodal irradiation, representing 3% of the entire cohort and 22% of pN+ patients. Overall, 1401 patients had an Oncotype DX recurrence score available, including 1273 patients with pN0 stage and 128 with pN1, with 173 (14%) and 16 (13%), respectively, having a recurrence score > 25, warranting chemotherapy.

Conclusions: While few cN0 postmenopausal women with HR+/HER2- tumors had nodal pathology that warranted ALND, receipt of nodal irradiation, or indicated need for chemotherapy, in 13%, SLNB would have an impact on consideration for PBI. Among patients eligible for PBI, findings from SLNB may help refine selection among postmenopausal women with this tumor profile.

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Figures

FIG. 1.
FIG. 1.
Adjuvant therapy assumptions. ALND axillary lymph node dissection, ACOSOG American College of Surgeons Oncology Group, SLN sentinel lymph node, PBI partial breast irradiation, ASTRO American Society for Radiation Oncology, DCIS ductal carcinoma in situ, LVI lymphovascular invasion, RNI regional nodal irradiation
FIG. 2.
FIG. 2.
Appropriateness of adjuvant therapy by pN status. (a) axillary lymph node dissection and regional nodal irradiation by pN status; (b) partial breast irradiation eligibility by pN status; (c) chemotherapy appropriateness by pN status. HR hormone receptor, HER2 human epidermal growth factor receptor 2, ALND axillary lymph node dissection, SLNB sentinel lymph node biopsy, RNI regional nodal irradiation, SLN sentinel lymph node, PBI partial breast irradiation
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