Extracapsular axillary node extension in patients receiving adjuvant systemic therapy: an indication for...

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Extracapsular extension (ECE) of axillary nodal metastases is a known risk factor in breast cancer.
• Patients with Stage II or III breast cancer and ECE often receive systemic therapy but may not receive loco-regional radiation.
• Understanding failure patterns in this specific patient group is crucial for optimizing treatment strategies.

Purpose of the Study:

• To review patterns of failure in 82 patients with Stage II or III breast cancer and extracapsular extension (ECE) of axillary nodal metastases.
• To evaluate the impact of ECE on survival and loco-regional recurrence in patients treated without loco-regional radiation.
• To identify prognostic factors associated with loco-regional recurrence in ECE-positive breast cancer patients.

Main Methods:

• Retrospective review of clinical records of 82 patients with Stage II or III breast cancer and ECE.
• Comparison of ECE-positive patients with 172 ECE-negative patients.
• Analysis of treatment modalities including mastectomy type, systemic therapy, and lack of loco-regional radiation.

Main Results:

• Seventy-eight percent of ECE-positive patients experienced recurrence, with 60% being loco-regional.
• ECE was a significant factor for survival and loco-regional failure in univariate analysis but not independently in multivariate analysis.
• Segmental mastectomy, positive margins, and ER-negative status increased loco-regional recurrence risk in ECE-positive patients.

Conclusions:

• Extracapsular extension is a significant prognostic factor for survival and loco-regional failure, indicating increased recurrence risk.
• Breast/chest wall and supraclavicular radiation is recommended for ECE-positive patients with adequate axillary dissection.
• Axillary irradiation should be considered for patients with limited axillary dissection and ECE.