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At full response to chemotherapy for breast cancer may have no meaning in the lymph node biopsy

March 23, 2018 10:03

Operation in the lymph node to check the spread of breast cancer can be avoided, even in women with invasive cancer if they respond well to initial treatment of breast cancer by chemotherapy, according to results of two new studies.

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The results, presented at the 11th European Conference on Breast Cancer, suggests that some women with triple negative breast cancer or women with HER2 positive tumor type can avoid axillary surgery and related adverse affects.

The spread of breast cancer to nearby lymph nodes, is a key indicator of the patient's prognosis. That is why the sentinel lymph node biopsy has been an important part of breast cancer treatment.

However, this procedure is associated with permanent adverse effects in some women, such as swelling, numbness and decreased movement of the hand.

These two studies provide clinicians with information about which patients are at very low risk of developing cancer in the lymph nodes after chemotherapy, which may allow them to reduce unnecessary operation when it is safe, to help professionals to tailor treatment for individual breast cancer patients.

To determine whether you can avoid axillary surgery breast cancer patients with tumors without touching on the lymph nodes (cN0), researchers studied 90 women with HER2 + and triple negative breast cancer cancer who underwent neoadjuvant therapy in the period from 2011 to 2016.

All women underwent axillary ultrasound, the results of which were confirmed by cytological testing.

Team found that before treatment in 54 (60%) women had the disease cN0; the remaining 36 (40%) had N1 disease.

Among patients with cN0 disease in 23 patients (42.5%) had a pathological complete response after neoadjuvant breast cancer treatment ; 52 (96.3%) showed no signs of metastases in the axillary lymph nodes.

Of the two patients (3.7%) with a residual axillary disease, none of them showed no pathologic complete response to treatment of breast cancer.

Among patients with N1 disease at 17 had a pathological complete response to neoadjuvant therapy of breast cancer. For 13 (76.5%) of these patients had no evidence of residual disease in axillary nodes.

This was significantly greater than that of the seven (36.8%) patients without residual axillary disease among patients without pathological complete response (P = 0,02).

The team found that women with a pathological complete response to treatment is traversed by breast cancer lower chances but diagnosis of positive results for lymph node metastases than women with no pathological complete response with a relative risk of 0.35.

According to the findings of researchers in women who had no signs of cancer in the lymph nodes and where the treatment of breast cancer seems to be skin cancer in the breast, lymph nodes, surgery could be avoided.

On the other hand, women who have had signs of cancer in the lymph nodes before treatment, there is still a risk that the disease will remain there, even if it can be successfully treated in most breast.

The results indicate that providing chemotherapy to patients with these types of breast cancer before considering surgery makes it possible to reduce or even avoid surgical treatment of breast cancer.

Another study examined 298 patients with breast cancer cN0. Scientists have searched for factors that were predictive factors of negative sentinel lymph nodes after neoadjuvant therapy.

The team found that 258 (86.6%) women were tumor negative sentinel lymph nodes in 16 (5.4%) was makrometastaz, 16 (5.4%) had micrometastases, and in eight (2.7% ) were isolated tumor cells.

There was a significant difference in the proportion of patients with negative sentinel lymph node testimony against tumor subtypes. Among patients with hormone-receptor-resistant (HR +), disease HER2 +, sentinel lymph nodes were negative in 78%; for patients with HER2 + / HR-disease results were negative by 100%; (P <0.001) for women with triple negative tumors, the results were negative for 98.5%.

It has been reported that women who have had a good response to chemotherapy for breast cancer, more likely to have negative indicators of metastases in the lymph nodes.

Among women who have had a reaction to the concomitant radiological response in the breast in 95.2% were negative lymph nodes, compared to 79.3% who did not (P <0,001). Among women who had a pathological complete response in 100% had negative lymph nodes, compared to 92.5% who did not (P <0,001).

In multivariate analysis, the researchers found that the only factor that was a significant predictor of the presence of negative sentinel lymph nodes was pathological complete response to chemotherapy for breast cancer.

These results suggest that sentinel lymph node biopsy is most likely not necessary for many women who are undergoing chemotherapy for breast cancer and have no signs of cancer in the lymph nodes before chemotherapy.

Source: MedsCape News


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