Adjuvant radiotherapy prevents locoregional relapses in patients with early breast cancer staged with sentinel node biopsy

The aim of this study is to establish the outcomes of breast cancer patients surgically staged with sentinel lymph node (SLN) biopsy and treated with adjuvant radiotherapy (RT), and to identify possible clinical or tumor-related factors that might help to prevent locoregional relapses. Method: retrospective study of 317 consecutive breast cancer patients cT1-T2 (<3cm), treated from January 2001 to December 2005 and followed at least for 7 years till 31st December 2012. Events recorded were: axillary lymph node relapse, ipsilateral breast tumor recurrence (BTR), contralateral breast cancer, and distant metastasis (DM). Results axillary recurrence occurred in 1 out of 190 SLN negative patients (0.5%). BTR occurred in 16 patients (5.0%), with a median of 20 months from RT. In multivariate analysis HER2+++ status was the only risk factor related to BTR. A BTR related to poor prognosis, as 38% developed metastasis. DM occurred in 7.9% with a median of 2.5 years from surgery. 6 years cancer related survival was 93.4% (297/317) and disease free survival was 88.6% (281/317). Conclusion adjuvant radiotherapy, in combination with standard systemic therapy, in early staged breast cancer patients provides excellent long term cure rates with low locoregional relapses. Risk factors identification and surgical stagement with SLN biopsy constitute an optimal approach in breast cancer management. Introduction Through the last years the Breast Cancer Units have being incorporating new technological advances to achieve a better characterization and treatment of breast cancer patients. Breast conservative surgery and sentinel lymph node (SLN) staging have become the two main pillars of the surgical management of early stage breast cancer [15]. A complete excision of the tumor followed by an adequate immune histological and hormonal study of the tumor and the SLN achieves an optimal knowledge of tumor biology to set the need or not of adjuvant treatment. Adjuvant radiotherapy is mandatory to consolidate local treatment and to reduce local recurrences in the breast or axilla in patients with conservative surgery with or without SLN metastasis. In a recent World J Surg Med Radiat Oncol 2013;2:54-63 Adjuvant Radiotherapy in early Breast Cancer 55 http://www.npplweb.com/wjsmro/content/2/8 systematic review of negative SLN patients, external beam radiation therapy of the breast associated with a significantly lower axillary recurrence rate than non radiated patients, based on the fact that breast or thoracic wall radiotherapy includes radiation of the lower part of the axilla [6]. It is our objective to establish our treatment outcomes of breast cancer patients treated with adjuvant radiotherapy since the performance of the sentinel node technique in 2001, selecting all consecutive patients till December 2005, and establishing the end point follow-up in 31st December 2012. All patients were followed until this date or till death. Also it is our aim to identify possible clinical or tumoral factors that might help to prevent loco-regional relapses. Material and Methods