Neoadjuvant chemotherapy reduces the necessity for regional nodal irradiation in breast cancer treatment

A study presented at the San Antonio Breast Cancer Symposium has shown that patients whose breast cancer had converted from lymph node-positive to lymph node-negative disease after receiving neoadjuvant chemotherapy are not at an increased risk of disease recurrence or death five years after surgery if they skip adjuvant regional nodal irradiation (RNI). There is currently no established standard of care for how such patients should be treated after surgery.

Dr. Eleftherios (Terry) Mamounas, chair of the NRG Oncology Breast Committee and professor of surgery at the University of Central Florida, mentions that there is debate in the medical field about the best treatment approach for these patients and whether they should be treated as patients with lymph node-positive or negative disease.

Although patients diagnosed with breast cancer that has spread to regional lymph nodes may undergo neoadjuvant chemotherapy, it may result in the complete eradication of the cancer from the lymph nodes. Currently, there is no established standard of care for how these patients should be treated after surgery.

In a phase III clinical trial, 1,641 patients diagnosed with lymph-node positive, nonmetastatic breast cancer were evaluated to determine the impact of RNI. Patients were randomly assigned to either the “no RNI” arm or the “RNI” arm.

The results of the study show that patients who receive adjuvant RNI have similar outcomes to those who do not. Over 90% of patients across both arms remained free of invasive breast cancer recurrences five years after surgery, indicating that downstaging cancer-positive regional lymph nodes with neoadjuvant chemotherapy can allow some patients to skip adjuvant RNI without adversely affecting oncologic outcomes. Follow-up of patients for long-term outcomes continues. As a potential limitation of the study, researchers observed fewer breast cancer recurrences than expected. However, they plan to conduct longer follow-ups to strengthen the analysis.

The study received support from the National Cancer Institute of the National Institutes of Health, and the authors have disclosed potential conflicts of interest related to the study.

Emily Thompson

Dr. Emily Thompson is a highly respected medical professional and seasoned health journalist, contributing her expertise to our news website. With a medical degree from Johns Hopkins University School of Medicine and over 15 years of experience in clinical practice, Dr. Thompson possesses a deep understanding of various health issues.
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