Abstract RF2-01: Factors Influencing Additional Nodal Disease and Pathologic Nodal Upstaging with Axillary Dissection in Patients with Residual Node-Positive Breast Cancer After Neoadjuvant Chemotherapy Enrolled on Alliance A011202 Clinical Trial
Abstract
Background: The Alliance for Clinical Trials in Oncology A011202 randomized phase III trial enrolled patients (pts) with clinical T1-3 N1 breast cancer (BC) with residual node-positive disease on sentinel lymph node (SLN) surgery after treatment with neoadjuvant chemotherapy (NAC) to assess whether the recurrence-free interval with radiation to the undissected axilla and regional LNs (AxRT group) is non-inferior to axillary lymph node dissection (ALND) with RT (ALND group). Herein we report on the nodal burden in both groups of pts prior to randomization, and the percentage of pts who had additional positive nodes in the ALND group. Methods: The pathologic findings from surgery after completion of NAC of all eligible pts were summarized using descriptive statistics. A positive SLN was defined as metastasis ≥0.2 mm present in a node harvested at SLN surgery. Fisher’s exact test was used to assess whether the post-chemotherapy pathologic (ypN) category increased with the number of positive LNs found on ALND. Results: Of 1627 eligible pts registered on A011202, 785 (48.2%) were randomized to ALND and 842 (51.8%) to AxRT. Median age at study entry was 51 years (range: 19-87). Clinical T category prior to NAC was: cT1 in 18.7%, cT2 in 58.9% and cT3 in 22.4% of ALND; cT1 in 20.2%, cT2 in 56.5% and cT3 in 23.3% of AxRT group. Tumor subtype distribution was: 12.1% ER-/PR-/HER2-, 18.6% HER2+, 69.3% ER+ and/or PR+ HER2-. Disease was grade III in 41.5% of ALND group and 38.6% of AxRT…
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