Cheptea Cezara, Kirova Youlia, Baude Jeremy, Laki Fatima, Fourquet Alain, Loap Pierre
Department of Radiation Oncology, Institut Curie, Paris, France.
Proton therapy center, Institut Curie, Orsay, France.
Strahlenther Onkol. 2025 May 6. doi: 10.1007/s00066-025-02409-9.
Isolated nodal recurrence (INR) after localized breast cancer is rare, with an incidence of less than 1%. Curative management typically includes surgical resection, often with axillary lymph node dissection (ALND), followed by regional nodal radiotherapy. However, evidence-based guidelines remain limited due to the rarity of this clinical scenario. The aim of this study was to evaluate survival determinants and the acute and long-term toxicities associated with second-course regional nodal irradiation as part of curative strategies for INR after localized breast cancer.
This retrospective study included 11 patients with localized breast cancer who developed ipsilateral, nonmetastatic INR between 2003 and 2019. All patients were treated with curative intent, including regional nodal irradiation. Overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), local control, and treatment toxicities were analyzed. Survival probabilities were calculated using the Kaplan-Meier method, and Cox regression was used to assess prognostic factors.
The 5‑year OS and CSS were 71.6%, while MFS was 62.3%. Inclusion of internal mammary chain (IMC) irradiation significantly improved OS, CSS, and MFS (p < 0.01). Triple-negative breast cancer (TNBC) INRs were associated with worse survival outcomes. Acute grade 2 toxicities included radiodermatitis (36.4%), and late grade 2 toxicities were limited to fibrosis (18.2%). No cardiac, pulmonary, or grade 3 or higher toxicities were reported.
This study highlights the favorable survival outcomes and safety profile of contemporary curative strategies for INRs following localized breast cancer, with a 5-year OS rate exceeding historical benchmarks. Internal mammary chain irradiation appears to improve survival without increased toxicity. However, the poor prognosis associated with TNBC INR underscores the need for effective systemic therapies. Prospective multicenter trials are essential to validate these findings and optimize treatment protocols.
局部乳腺癌后孤立性淋巴结复发（INR）很少见，发生率低于1%。根治性治疗通常包括手术切除，常伴有腋窝淋巴结清扫（ALND），随后进行区域淋巴结放疗。然而，由于这种临床情况罕见，基于证据的指南仍然有限。本研究的目的是评估生存决定因素以及与第二疗程区域淋巴结照射相关的急性和长期毒性，作为局部乳腺癌后INR根治性策略的一部分。
这项回顾性研究纳入了2003年至2019年间发生同侧非转移性INR的11例局部乳腺癌患者。所有患者均接受根治性治疗，包括区域淋巴结照射。分析了总生存期（OS）、癌症特异性生存期（CSS）、无转移生存期（MFS）、局部控制情况和治疗毒性。使用Kaplan-Meier方法计算生存概率，并使用Cox回归评估预后因素。
5年总生存率和癌症特异性生存率分别为71.6%，无转移生存率为62.3%。纳入内乳链（IMC）照射显著改善了总生存期、癌症特异性生存期和无转移生存期（p<0.01）。三阴性乳腺癌（TNBC）的INR与较差的生存结果相关。急性2级毒性包括放射性皮炎（36.4%），晚期2级毒性仅限于纤维化（18.2%）。未报告心脏、肺部或3级及以上毒性。
本研究强调了局部乳腺癌后INR当代根治性策略良好的生存结果和安全性，5年总生存率超过历史基准。内乳链照射似乎可提高生存率且不增加毒性。然而，TNBC的INR预后不良凸显了有效全身治疗的必要性。前瞻性多中心试验对于验证这些发现和优化治疗方案至关重要。
