Axillary lymph node failure in patients treated with accelerated partial breast irradiation

Abstract

BACKGROUND: Data on the risk of axillary failure (AF) after accelerated partial breast irradiation (APBI) are limited. In this study, the authors determined the rate of AF and regional lymph node failure (RNF) in patients who received various forms of APBI and identified factors that were associated with its occurrence. METHODS: In total, 534 patients with early stage breast cancer were treated at William Beaumont Hospital with APBI, including 466 patients (87%) with invasive breast cancer and 68 patients (13%) with ductal carcinoma in situ. Clinical variables (patient age, tumor location), pathologic variables (tumor size, grade, estrogen receptor status, margin status, lymph node status), and treatment-related variables (receipt of hormone and systemic chemotherapy) were analyzed to determine which factors were associated with AF and RNF. The median length of follow-up was 63 months (range, 1-201 months). RESULTS: The 5-year actuarial AF rate was 0.19%. Three patients (0.56%) developed RNF (all patients initially had invasive breast cancer) with a 5-year actuarial rate of 0.37%. Two of the regional recurrences were in the supraclavicular fossa, and 1 was in the axilla. No variables were associated with AF. However, patient numbers were very small. The median survival after RNF was 0.8 years (range, 0.3-1.7 years), and 2 of the 3 patients died of disease. CONCLUSIONS: The rate of AF and RNF after APBI was low and appeared to be similar to the rate observed with whole-breast irradiation. No variables were associated with a higher rate of AF after APBI. Cancer 2012;118:38-

Efficacy and Safety of Accelerated Partial Breast Irradiation after Breast-conserving Surgery: A Meta-analysis of Published Comparative Studies

“…A registry trial of 1,500 patients treated with the MammoSite device has reported LR in 3.8% and AF in 0.79% with mean follow‐up of 5 years, the rate of LR and AF after MammoSite APBI is low and appears to be similar to that achieved with WBI . Another trial of 534 patients treated with three APBI techniques included interstitial brachytherapy ( n = 221), balloon‐based brachytherapy ( n = 207), and 3D‐CRT ( n = 106) has also reported a low AF (0.19%) with follow‐up of 5 years . The results of these trials are consistent with our analysis.…”