Outcomes after Sentinel Lymph Node Biopsy and Radiotherapy i
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Results of this JAMA Network study suggest that deimplementation of both sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy (RT) interventions should be strongly considered in older patients with estrogen receptor–positive, clinically node-negative breast cancer.

The objective of the study was to describe the use rates and association with disease recurrence of SLNB and RT in older women with breast cancer.

This cohort study obtained patient and clinical data from an integrated cancer registry and electronic health record of a single health care system in Pennsylvania. The cohort was composed of consecutive female patients 70 years or older who were diagnosed with early-stage, estrogen-receptor-positive, ERBB2 (formerly HER2)–negative, clinically node-negative breast cancer who were treated at 15 community and academic hospitals within the health system.

From 2010 to 2018, a total of 3361 women 70 years or older with estrogen receptor–positive, ERBB2-negative, clinically node-negative breast cancer were included in the study. The outcomes were;

--Of these women, 2195 received SLNB and 1828 received adjuvant RT. Rates of SLNB steadily increased, a trend that persisted after the 2016 adoption of the Choosing Wisely guideline. Rates of RT decreased slightly.

--To examine patient outcomes and maximize follow-up time, the analysis was limited to cases from 2010 to 2014, identifying 2109 patients with a median follow-up time of 4.1 years.

--In the propensity score–matched cohorts, no association was found between SLNB and either locoregional recurrence-free survival (LRFS) rate or disease-free survival (DFS).

--In addition, RT was not associated with LRFS or DFS.

--Subgroup analysis showed that stratification by tumor grade or comorbidity was not associated with LRFS or DFS.

--Low absolute rates of recurrence were observed when comparing the groups that received SLNB and those that did not as well as the groups that received RT and those that did not.

This study found that receipt of SLNB or RT was not associated with improved LRFS or DFS in older patients with ER-positive, clinically node-negative breast cancer. Despite limited follow-up time and wide 95% CIs, this study supports the continued deimplementation of both SLNB and RT in accordance with the Choosing Wisely and National Comprehensive Cancer Network guidelines.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2778563