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. 2025 Oct 27.
doi: 10.1245/s10434-025-18631-9. Online ahead of print.

Simultaneous Omission of Sentinel Lymph Node Biopsy and Radiation in Older Women with Early ER+ Breast Cancer

Chase E Cox  1 , Jessica Schumacher  1 , Margaret Lillie  2 , Joshua Carino  2 , Yash Agrawal  3 , Julia M Selfridge  1   2 , Kristalyn K Gallagher  1   2 , David W Ollila  1   2 , Dana L Casey  2   4 , Caprice C Greenberg  1   2 , Philip M Spanheimer  5   6   7
Affiliations

Simultaneous Omission of Sentinel Lymph Node Biopsy and Radiation in Older Women with Early ER+ Breast Cancer

Chase E Cox et al. Ann Surg Oncol. .

Abstract

Introduction: Oncologic outcome data on women with neither SLNB nor radiation are limited. We evaluated recurrence and survival in older women with early stage, ER+/HER2 negative breast cancer who underwent lumpectomy without SLNB or radiation.

Patients and methods: Women treated for breast cancer from 2014 to 2022 were identified in a local tumor registry. Inclusion criteria were women 65 years and older, tumor size ≤ 5 cm, ER+ > 10%, HER2- invasive breast cancers treated with lumpectomy without SLNB or radiation. The Kaplan-Meier method was used to estimate curves for mortality and recurrence.

Results: A total of 116 women met inclusion criteria. Median age at time of surgery was 76 (IQR: 72-80) years. The majority of patients were white (85%). Most patients had a T1 tumor (85%) and ductal histology (78%). In total, 107 patients (92%) initiated adjuvant endocrine therapy with median therapy duration of 4.2 years. Of the 116 patients, 7 developed recurrence (6.0%). Of the seven recurrences, all were initially locoregional: six in breast and one axillary. Three women with recurrence underwent mastectomy (5 year mastectomy-free survival 97.4%).

Discussion: Locoregional recurrence was rare at a median follow up of over 5 years with simultaneous omission of SLNB and radiation in older women with early stage ER+, HER2- breast tumors. Death from non cancer causes was more common, highlighting the competing risks in this population. These findings support the oncologic safety of this approach in well selected patients-older women with low risk tumors.

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