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Gustavo Viani: The nodal burden and oncologic outcomes in patients with ITCs in SLNs after NAC

Gustavo Viani/onconews.com.br

Nov 12, 2024, 16:31

Gustavo Viani: The nodal burden and oncologic outcomes in patients with ITCs in SLNs after NAC

Gustavo Viani, Associate Professor at FMRP-USP, shared a post on LinkedIn about a recent paper by Giacomo Montagna, Breast Surgeon at Memorial Sloan Kettering Cancer Center:

“Nodal Burden and Oncologic Outcomes in Patients With Residual Isolated Tumor Cells After Neoadjuvant Chemotherapy (ypN0i+): The OPBC-05/ICARO Study”

Authors: Giacomo Montagna, Alison Laws, Massimo Ferrucci, Monica Morrow, Walter Weber et al.

“Residual isolated tumor cells (ITCs) in the sentinel lymph nodes (SLNs) after neoadjuvant chemotherapy (NAC) (ypN0i+) should not affect the management of the axilla in breast cancer patients.

Objective:

To investigate the nodal burden and oncologic outcomes in patients with ITCs in SLNs (ypN0i+) after NAC, comparing those treated with and without axillary lymph node dissection (ALND)

Methods:

Retrospective analysis of 583 patients with stage I-III breast cancer
Patients were divided into two groups:
ALND (182 patients, 31%)
No ALND (401 patients, 69%)
1st endpoint: 3-year rate of any axillary recurrence
2ndendpoint: 3-year rate of any invasive recurrence

Key Findings:

Patients who underwent ALND had a higher likelihood of:

Advanced nodal disease (cN2/3) at diagnosis (17% vs. 7%)
ITCs detected on frozen section (62% vs. 8%)
Lymphovascular invasion (38% vs. 24%)
Receiving adjuvant chest wall (89% vs. 78%) and nodal radiation (82% vs. 75%)

Nodal Findings:

Additional positive lymph nodes were found in 30% of patients who underwent ALND, but only 5% had macrometastases

Recurrence Rates:

3-year axillary recurrence rate: 2% (95% CI: 0.95 to 3.6)
3-year invasive recurrence rate: 11% (95% CI: 8 to 14)
No significant difference in recurrence based on the type of axillary surgery performed

These findings do not support routine ALND in all patients with ypN0(i+). This data contributes to refining axillary management and potentially sparing patients from unnecessary surgical interventions.”

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Gustavo Viani, MD is an Associate Professor in the Department of Medical Imaging, Hematology, and Oncology at Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP).

Dr. Viani’s research focuses on radiation oncology, with expertise in brachytherapy, stereotactic radiosurgery, dose fractionation, radiation tolerance, and overall oncology practices.