Falco Michał, Masojć Bartłomiej, Kram Andrzej
Radiation Oncology Department, West Pomeranian Oncology Center, Szczecin, Poland.
Pathology Department, West Pomeranian Oncology Center, Szczecin, Poland.
Rep Pract Oncol Radiother. 2021 Sep 30;26(5):785-792. doi: 10.5603/RPOR.a2021.0101. eCollection 2021.
Breast cancer patients with positive sentinel lymph node biopsy (SLNB) may be spared axillary lymph node dissection (ALND) in favour of irradiation. The aim of the study was to estimate local control probability in the axilla (axLCP).
We identified 1832 invasive breast cancer patients who had undergone SLNB at our centre. We measured maximal metastasis diameter (SLDmax) in the sentinel lymph nodes and lymph node metastasis volume (VALN) from ALND in 246 patients with one or two positive SLNs. We calculated axLCP after irradiation and systemic treatment for different molecular types.
VALN values are higher for high grade tumours and larger metastases in SLNs (> 5 mm). It is smaller in luminal A tumours. axLCP is high, nearly 100%, in all molecular types in radiation sensitive tumours (SF2 Gy = 0.45), except luminal B. Expected axLCP is relatively low (67%) in luminal B radiation sensitive tumours with no chemotherapy and nearly 100% with chemotherapy.
VALN values differ among molecular tumour types. They depend on SLNDmax and tumour grade. New prognostic factors are needed for selected luminal B breast cancer patients (i.e. high grade tumours, large metastases in SLNs) after positive SLNB intended to be spared ALND and chemotherapy.
前哨淋巴结活检（SLNB）结果为阳性的乳腺癌患者，可能无需进行腋窝淋巴结清扫（ALND），而采用放射治疗。本研究的目的是评估腋窝局部控制概率（axLCP）。
我们确定了1832例在本中心接受过SLNB的浸润性乳腺癌患者。我们测量了246例有一个或两个前哨淋巴结阳性患者的前哨淋巴结最大转移直径（SLDmax）和腋窝淋巴结清扫术中的淋巴结转移体积（VALN）。我们计算了不同分子类型在放疗和全身治疗后的axLCP。
高级别肿瘤以及前哨淋巴结中转移灶较大（>5mm）的患者VALN值较高。管腔A型肿瘤的VALN值较小。除管腔B型外，放射敏感肿瘤（SF2Gy = 0.45）的所有分子类型的axLCP都很高，接近100%。在未进行化疗的管腔B型放射敏感肿瘤中，预期axLCP相对较低（67%），而进行化疗时则接近100%。
VALN值在不同分子肿瘤类型之间存在差异。它们取决于SLNDmax和肿瘤分级。对于前哨淋巴结活检阳性且打算避免进行ALND和化疗的特定管腔B型乳腺癌患者（即高级别肿瘤、前哨淋巴结中有大转移灶），需要新的预后因素。
