Abstract P2-12-04: Is there any benefit to perform extensive nodal dissection in primary or recurrent aggressive form of breast cancer?
Authors: Berliere M , Duhoux F , Nardai P , Schmitz S , Taburiaux L , Galant C , Leconte I , Piette P , Lengele B 
Published: May 2016

Background: Breast oncologic surgery and especially nodal surgery has become ever more minimally invasive. However, some aggressive breast cancers exhibit at their primary or recurrent presentation extensive nodal invasion at the axillary, retropectoralis and sometimes supraclavicular and cervical levels. Surgical treatment of these tumors is not standardized.

Material and methods: Between January 2012 and April 2015, 7 primary breast cancer patients (group I) and 7 recurrent breast cancer patients (group II) were included in a prospective, non randomized study approved by our local ethics committee. All the patients had cytologically proven retropectoralis and infraclavicular lymph node invasion and 7 of them had cytologically proven cervical lymph node invasion (5 in the group of primary tumors and 2 in the group of recurrences). Four of the 7 primary tumors were triple negative and 3 were HER2 positive tumors, while 4 out of the 7 recurrent tumors were triple negative and 3were HER2 positive. All the patients underwent PET/CT and breast MRI at baseline. Visceral metastases were absent in all cases. In the group of primary tumors, all the patients were treated with neoadjuvant chemotherapy (plus trastuzumab for the 3 HER2 positive tumors); in the group of recurrent tumors, neoadjuvant chemotherapy associated with trastuzumab was administered in 3 patients, while the 4 other patients underwent complementary mastectomy plus extensive nodal surgery followed by chemotherapy. Radiotherapy was administered in all primary breast cancer patients and cervical radiotherapy was administered in 3 of the 7 recurrent diseases. The following parameters were assessed: disease-free survival, overall survival and adverse events of surgical treatment.

Results: All the patients are still alive after a relatively short mean duration of follow-up [24 months in group I (6 to 40 months) and 29 months in group II (3 to 39 months)]. Six of the 7 patients in group I have no signs of recurrence, one has metastatic evolution (bilateral cervical and mediastinal node evolution) and is currently receiving chemotherapy in combination with a PARP inhibitor. In group II, 6 of the 7 patients have no signs of recurrence and one has metastatic evolution (inguinal nodes and bone metastases), treated with chemotherapy and HER2-targeted therapy. The major adverse event is arm lymphedema, affecting 4 out of 14 patients (28%). No persistent pain nor motor troubles are noted.

Discussion: Patients with nodal metastases outside the axilla seem to benefit from extensive surgery integrated in a multidisciplinary therapeutic approach. Some studies have demonstrated survival benefits for patients undergoing surgical resection of these nodes.

Conclusion: In aggressive breast tumors (HER2 positive or triple negative tumors) presenting with extensive nodal invasion, surgical excision of these nodal metastases must be integrated in the multidisciplinary treatment and patients need to be followed prospectively for a long time to confirm survival benefits.

Citation Format: Berliere M, Duhoux F, Nardai P, Schmitz S, Taburiaux L, Galant C, Leconte I, Piette P, Lengele B. Is there any benefit to perform extensive nodal dissection in primary or recurrent aggressive form of breast cancer?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-04.