One of the key goals of neoadjuvant chemotherapy (NAC) is to downstage axilla and performing sentinel node biopsy (SLNB) after NAC then allows de-escalation of surgical treatment of axilla 1. Development and Validation of a Nomogram to Predict Lymphedema After Axillary Surgery and Radiation Therapy in Women With Breast Cancer Fro Gross JP, Whelan TJ, Parulekar WR, Chen BE, Rademaker AW, Helenowski IB et al. The Role of the Neo-Bioscore Staging System in Guiding the Optimal Strategies for Regional Nodal Irradiation Following Neoadjuvant Treatment in Breast Cancer Patients with cN1 and ypN0-1. Cao L, Xu C, Kirova YM, Cai G, Cai R, Wang SB et al. Is elective nodal irradiation beneficial in patients with pathologically negative lymph nodes after neoadjuvant chemotherapy and breast-conserving surgery for clinical stage II-III breast cancer? A multicentre retrospective study (KROG 12-05). Noh JM, Park W, Suh CO, Keum KC, Kim YB, Shin KH et al. Role of Elective Nodal Irradiation in Patients With ypN0 After Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery (KROG 16-16). Cho WK, Park W, Choi DH, Kim YB, Kim JH, Kim SS et al. Nodal Recurrence in Patients With Node-Positive Breast Cancer Treated With Sentinel Node Biopsy Alone After Neoadjuvant Chemotherapy-A Rare Event. Barrio AV, Montagna G, Mamtani A, Sevilimedu V, Edelweiss M, Capko D et al. We are looking forward the reply from authors and more relative RCTs in future.ġ. If negative results were showed in further analysis and multicenter randomized controlled trials (RCTs), RNI can be avoided for selected patients, and notable relative reduction of lymphedema risk (from 23.3% to 57.5%) can be expected. To be clinically applicable, results need to be validated. Of course, unplanned analyses can be used only to generate hypotheses. We suggest that Barrio and colleagues analyze the difference of survival and recurrence patterns between patients received nodal radiotherapy (n=164) or not (n=70). We believe further investigation is needed. But whether the RNI can be omitted for those patients with cN1 and ypN0 disease when staging by SLNB? Standardized SLNB approach showed low false-negative rates (FNRs, <10%) for patients with cN1 and ypN0 breast cancer and is reasonable alternative to stage the axilla after NAC. also demonstrated that RNI did not improve survival for breast cancer patients with cN1 and ypN0 disease (n=89), with 88.9% patients received Mastectomy and 97.5% patients received ALND. Another retrospective study conducted by Cao Lu et al. However, more than 80% patients in these two studies received axillary lymph node dissection (ALND) but not SLNB. Two multi-institutional studies (KROG 16-16 and KROG 12-05) failed to identify any benefit from RNI in ypN0 patients after NAC and breast-conserving surgery (BCS). We would like to congratulate the authors for their efforts in performing this study.Īs radiation therapist, we have a great interest in the role of regional nodal radiotherapy (RNI) for those breast cancer patients with cN1 and ypN0 disease after standardized SLNB technique. which found that breast cancer patients with cN1 disease, who achieve nodal pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC), can be treated with sentinel lymph node biopsy (SLNB) alone with 3 or more negative SLNs retrieved, and suffered low rate of nodal recurrence (0.4%). We write regarding the recent paper by Barrio et al. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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