Locoregional Management of Early-Stage Breast Cancer

The latest version of NCCN Guidelines for Breast Cancer on locoregional management of early-stage breast cancer contains numerous updated recommendations, particularly focusing on management of the axilla, locoregional management after neoadjuvant therapy, and radiation delivery. Recommendations for axillary staging have been separated for patients who have undergone breast-conserving surgery and those who have had a mastectomy, creating 2 individual pathways. The section on locoregional treatment after neoadjuvant therapy has been reformatted; optimal management of this patient group continues to evolve. Lastly, specifics regarding the delivery and sequencing of radiotherapy have been updated.

Disclosures: Dr. Moran has disclosed having no relevant financial relationships. Dr. Leitch has disclosed receiving consulting fees from AstraZeneca Pharmaceuticals LP and Puma Biotechnology.

Correspondence: Meena S. Moran, MD, Yale University School of Medicine, Therapeutic Radiology, 15 York Street, Smilow YNHH, New Haven, CT 06504. Email: meena.moran@yale.edu; and A. Marilyn Leitch, MD, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390. Email: marilyn.leitch@utsouthwestern.edu
  • 1.

    Whelan TJ, Olivotta IA, Parulekar WR, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med 2015;373:307316.

  • 2.

    Poortmans PM, Weltens C, Fortpied C, et al. Internal mammary and medial supraclavicular lymph node chain irradiation in stage I-III breast cancer (EORTC 22922/10925): 15-year results of a randomised, phase 3 trial. Lancet Oncol 2020;21:16021610.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Gradishar WJ, Moran MS, Abraham J, et al. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Breast Cancer. Version 2.2022. Accessed March 21, 2022. To view the most recent version, visit NCCN.org

    • Search Google Scholar
    • Export Citation
  • 4.

    Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA 2017;318:918926.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Gentile D, Gatzemeier W, Barbieri E, et al. Preservation of axillary lymph nodes compared to complete dissection in T1-T2 breast cancer patients presenting with 1-2 metastatic sentinel lymph nodes: a multicenter randomized clinical trial. Sinodar One [abstract]. Presented at the 2021 San Antonio Breast Cancer Symposium; December 7–10, 2021; San Antonio, Texas. Abstract GS4-05.

    • Search Google Scholar
    • Export Citation
  • 6.

    Rutgers EJ, Donker M, Poncet C, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer patients: 10 year follow up results of the EORTC AMAROS trial (EORTC 10981/22023) [abstract]. Presented at the 2018 San Antonio Breast Cancer Symposium; December 4–8, 2018; San Antonio, Texas. Abstract GS4-01.

    • Search Google Scholar
    • Export Citation
  • 7.

    Sávolt Á, Péley G, Polgár C, et al. Eight-year follow up result of the OTOASOR trial: the optimal treatment of the axilla - surgery or radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer: a randomized, single centre, phase III, non-inferiority trial. Eur J Surg Oncol 2017;43:672679.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Kim YB, Byun HK, Kim DY, et al. Effect of elective internal mammary node irradiation on disease-free survival in women with node-positive breast cancer: a randomized phase 3 clinical trial. JAMA Oncol 2022;8:96105.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 2013;310:14551461.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Kantor O, Wakeman M, Weiss A, et al. Axillary management after neoadjuvant endocrine therapy for hormone receptor-positive breast cancer. Ann Surg Oncol 2021;28:13581367.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Brunt AM, Haviland JS, Sydenham M, et al. Ten-year results of FAST: a randomized controlled trial of 5-fraction whole-breast radiotherapy for early breast cancer. J Clin Oncol 2020;38:32613272.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Brunt AM, Haviland JS, Wheatley DA, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet 2020;395:16131626.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Yong-Hing CJ, Ito C, Corke L, et al. Clip placement after ultrasound guided biopsy in the setting of neoadjuvant chemotherapy [abstract]. Presented at the 2021 San Antonio Breast Cancer Symposium; December 7–10, 2021; San Antonio, Texas. Abstract P1-03-02.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 502 502 502
PDF Downloads 262 262 262
EPUB Downloads 0 0 0