title: Characteristics and outcomes of sentinel node-positive breast cancer patients after total mastectomy without axillary-specific treatment.
abstract: OBJECTIVE
  Regional failure rates are low in patients with a positive sentinel lymph node biopsy (SLNB) who undergo breast-conserving therapy without axillary lymph node dissection (ALND). The applicability of these findings to total mastectomy (TM) patients is not established. Our aims were to evaluate the characteristics and outcomes of SLNB-positive TM patients who did not receive axillary-specific treatment and to compare them to similar patients who underwent breast-conserving surgery (BCS).
  
  
  METHODS
  A total of 535 patients with early-stage breast cancer who underwent definitive breast surgery (210 TM, 325 BCS), had a positive SLNB and did not receive ALND between 1997 and 2009 were identified from an institutional database. Characteristics and outcomes were compared between the TM and BCS groups.
  
  
  RESULTS
  Most patients had stage I to IIA, estrogen receptor-positive, progesterone receptor-positive, Her2-negative invasive ductal carcinoma, with minimal nodal disease. Compared to the BCS group, TM patients were younger, had larger tumors, had higher nomogram scores predicting additional axillary disease and were more likely to receive chemotherapy. Ninety-four percent of the BCS cohort and 5 % of the TM cohort received adjuvant radiotherapy. At a median follow-up of 57.8 months, the 4-year local, regional and distant failure rates were 1.7, 1.2 and 0.7 % in the TM group and 1.4, 1.0 and 3.7 % in the BCS group. The 4-year disease-free and overall survival rates were 94.8 and 97.8 % in the TM group and 90.1 and 92.6 % in the BCS group.
  
  
  CONCLUSIONS
  Early-stage breast cancer patients with minimal sentinel node disease experience excellent outcomes without ALND, whether they undergo BCS or TM.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Milgrom
authors.forename: Hiram
authors.initials: H
authors.lastname: Cody
authors.forename: Lee
authors.initials: L
authors.lastname: Tan
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.forename: Catherine
authors.initials: C
authors.lastname: Pesce
authors.forename: Jeremy
authors.initials: J
authors.lastname: Setton
authors.forename: Katherine
authors.initials: K
authors.lastname: Rogers
authors.forename: Brittany
authors.initials: B
authors.lastname: Arnold
authors.forename: Anne
authors.initials: A
authors.lastname: Eaton
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Catalano
authors.forename: Beryl
authors.initials: B
authors.lastname: McCormick
authors.forename: Simon
authors.initials: S
authors.lastname: Powell
authors.forename: Alice
authors.initials: A
authors.lastname: Ho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D015413:Mastectomy, Simple; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone