El-Jammal Mohamad, Saifi Omran, Bazan Jose, Zeidan Youssef H
Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA.
BMC Cancer. 2025 Jun 4;25(1):996. doi: 10.1186/s12885-025-14289-4.
The benefit of regional nodal irradiation (RNI) following modern primary systemic therapy (PST) in HER2-positive breast cancer (HER2 + BC) remains under investigation. The current study evaluates RNI practice patterns and outcomes based on the pathological response to PST in clinically node-positive (cN+) HER2 + BC.
TRYPHAENA and NeoSphere are two randomized phase II trials that investigated PST for HER2 + BC. The current study is a pooled analysis of both trials, focusing on cN + patients treated with HER2-targeted PST followed by breast-conserving surgery. The primary goal is to describe patterns of RNI practicein this population and its impact on breast cancer recurrence-free survival (BCRFS) and loco-regional recurrence-free survival (LRRFS).
Our analysis included a total of 90 patients with cN + disease. Complete nodal pathological response was achieved in 53 patients (58.9%). Patients with ypN0 had a 5-year LRRFS of 95.83% whereas patients with ypN + had 5-year LRRFS of 87.43% (p = 0.105). RNI was used in 16 ypN0 (48.5%) patients and 17 ypN+ (51.5%) patients. Patients treated with RNI had 5-year LRRFS of 93.4% as compared to 92.5% in the no RNI group (p = 0.868). Distant metastasis was detected in 5 patients (5%) with the most common sites being: liver, lung, bone, and CNS. Locoregional recurrence was significantly associated with distant failure (p = 0.002).
cN + HER2 + BC patients who achieve ypN0 after PST have excellent locoregional control. In contrast, patients with ypN + tend to have lower locoregional control. The utility of RNI in HER2 + BC warrants further investigation.
在人表皮生长因子受体2阳性乳腺癌（HER2 + BC）中，现代原发性全身治疗（PST）后进行区域淋巴结照射（RNI）的获益仍在研究中。本研究基于临床淋巴结阳性（cN+）HER2 + BC患者对PST的病理反应，评估RNI的应用模式和结果。
TRYPHAENA和NeoSphere是两项研究HER2 + BC的PST的随机II期试验。本研究是对这两项试验的汇总分析，重点关注接受HER2靶向PST并随后进行保乳手术的cN+患者。主要目标是描述该人群中RNI的应用模式及其对乳腺癌无复发生存期（BCRFS）和局部区域无复发生存期（LRRFS）的影响。
我们的分析共纳入90例cN+疾病患者。53例患者（58.9%）实现了淋巴结完全病理缓解。ypN0患者的5年LRRFS为95.83%，而ypN+患者的5年LRRFS为87.43%（p = 0.105）。16例ypN0（48.5%）患者和17例ypN+（51.5%）患者接受了RNI。接受RNI治疗的患者5年LRRFS为93.4%，而未接受RNI组为92.5%（p = 0.868）。5例患者（5%）发生远处转移，最常见部位为肝脏、肺、骨和中枢神经系统。局部区域复发与远处转移显著相关（p = 0.002）。
PST后达到ypN0的cN+ HER2 + BC患者具有良好的局部区域控制。相比之下，ypN+患者的局部区域控制往往较低。RNI在HER2 + BC中的效用值得进一步研究。
