Mastectomy enough treatment for early breast cancer

There appears to be no need for additional axillary surgery or radiotherapy in early breast cancer patients after surgical intervention, according to a new study presented at the recently concluded 2019 Asia Congress of the European Society for Medical Oncology (ESMO Asia 2019).

“There is little known about the prognosis for early breast cancer patients who are not receiving adjuvant radiotherapy after mastectomy with sentinel lymph node biopsy,” researchers said. “The purpose of this study was to evaluate the characteristics and outcomes of [these patients].”

The researchers retrospectively assessed the clinicopathological data of 104 patients with early breast cancer who had undergone total mastectomy, skin-sparing mastectomy or nipple areolar complex-sparing mastectomy. Most of the participants had T1, hormone receptor-positive disease. Outcomes included overall survival, overall recurrence-free survival, distant recurrence rate and locoregional recurrence rate.

Over a median follow-up of 53 months, 85 patients had total mastectomy (TM; median age, 53.0 years); 19 had either nipple areolar complex-sparing or eight skin-sparing mastectomies (NSM/SSM; median age, 45 years). None of the participants received adjuvant radiotherapy in the chest area. More than half in both groups opted to receive chemotherapy. [ESMO Asia 2019, abstract 22P]

Patients who underwent TM had significantly better locoregional recurrence-free survival than their NSM/SSM counterparts (95.3 percent vs 78.9 percent; p=0.037). An inverse pattern was observed for locoregional failure rates.

Distant recurrence-free survival rates were likewise high in both patient subgroups, though a slight, nominal advantage of TM emerged (97.6 percent vs 89.5 percent; p=0.128). The same was true for overall recurrence-free survival rates (92.9 percent vs 78.9 percent; p=0.118).

Overall survival was comparable and high in both patient groups (TM vs NSM/SSM: 98.8 percent vs 94.7 percent; p=0.289).

There were two deaths reported, one occurring in each group. The patient death in the TM group was due to end-stage renal disease complications and deemed unrelated to breast cancer. The mortality in the NSM/SSM group was malignancy-related.

“In conclusion, early breast cancer patients who underwent total mastectomy, skin-sparing mastectomy or nipple areolar complex-sparing mastectomy with sentinel lymph node biopsy had excellent outcomes without additional axillary surgery or radiotherapy,” the researchers said.

“Further evaluation should be warranted for assessing the effect of adjuvant radiation therapy in early breast cancer who underwent sentinel lymph node biopsy,” they added. “There is a need for comparison with patients who received radiation after breast-conserving surgery with sentinel lymph node biopsy.”