Regional Recurrence Risk Following a Negative Sentinel Node Procedure Does Not Approximate the False-Negative Rate of the Sentinel Node Procedure in Breast Cancer Patients Not Receiving Radiotherapy or Systemic Treatment

Quantifying the Mitigating Effects of Whole-Breast Radiotherapy and Systemic Treatments on Regional Recurrence Incidence Among Breast Cancer Patients

“…In a previous study, we concluded that not all residual lymph node metastases will develop into clinically overt RR when left untreated. 9 As such, this finding coincides with randomized trials in the past comparing ALND with no-ALND and reporting much lower RR rates based on the incidence of nodal metastases in the ALND arm of the study. 10 On the one hand, this may be explained by the natural course of nodal metastases, but on the other hand, it also may be due to the fact that DMs occur before the nodal metastases become clinically overt.…”

“…We demonstrated that the three described methods at least halved the risk. When we also take into account the historical finding of the NSABP-04 trial that residual metastatic lymph nodes will not automatically develop into a clinically detectable RR, even in the absence of the aforementioned therapies, 9,10 the findings of the current study may help to explain the observed discrepancy between the false-negative rate of SLNB and regional recurrence in N0 patients. If we extrapolate the effect size of the nonsurgical treatments administered to SLNB N?…”

“…In a previous study, we evaluated the ''natural course'' RR development in patients who underwent ablative surgery, had a tumor-free SLNB, and did not receive additional nonsurgical treatments. 9 The observed risk for the development of an RR (2.4%) was less than half the false-negative rate (5-7%) of the procedure, implying that residual lymph node metastases do not automatically develop into RR when left untreated. As such, this observation closely resembled the historical findings of the National Surgical Adjuvant Breast and Bowel Project (NSABP)-04 trial, in which less than half of the patients with nodal metastases (based on the incidence of metastases in the ALND arm) experienced clinically apparent RR although none of these patients had received adjuvant systemic therapy or RT.…”

Effects of the Number of Removed Lymph Nodes on Survival Outcome in Patients With Sentinel Node-negative Breast Cancer.

“…It should be noted, despite a good lymph node collection, patients are still exposed to the risk of local or distant recurrence. Previous experiences also suggest that certain characteristics such as multifocal disease or parameter T can modify both the risk of lymph node involvement of the axillar and the risk of disease recurrence (both local and distant) [13]. The results of our study rst con rm that the T parameter in uences the appearance of RRs (T1 = 1.8%; T2 2.4%, T3 = 10.5% -Chi-square 12.9; p = 0.002).…”

ASO Author Reflections: Effect Sizes of Whole Breast Radiotherapy and Systemic Therapies on Regional Recurrence Incidence in Breast Cancer Patients

“… 1 Moreover, landmark randomized controlled trials (RCTs) in patients who do have a tumor-positive SLNB but do not undergo completion axillary lymph node dissection (ALND) show that these patients will also rarely develop axillary recurrences despite an almost 30% chance of having residual positive lymph nodes. 2 Apart from an National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol B-04-like self-limiting phenomenon that we recently demonstrated in a study in SLNB N0 patients who had undergone ablative surgery without receiving further additional treatment and had a RR risk of only 2%, 3 adjuvant radiotherapy (RT) and systemic treatments are factors that temper the growth of metastases in the axilla. In the present study, we aimed to quantify the effects of whole-breast RT and systemic treatments on the RR incidence in a large-population-based cohort of SLN N0 breast cancer patients.…”