Dr Haffty on Radiation in Node-Positive Breast Cancer That Converts to Node Negative

Bruce G. Haffty, MD, MS, FACR, FASTRO, chair, Radiation Oncology, associate vice chancellor for Cancer Programs, Rutgers Cancer Institute of New Jersey, system director, Radiation Oncology, RWJ Barnabas Health, discusses the evolving considerations regarding the omission of regional nodal radiation therapy in patients with node-positive breast cancer who convert to node-negative status after neoadjuvant chemotherapy.

In a presentation at the 23rd Annual International Congress on the Future of Breast Cancer® East, Haffty highlighted that findings from the phase 3 NRG/NSABP B-51/RTOG 1304 trial (NCT01872975) suggested patients who initially present with positive lymph nodes and achieved node-negative status after receiving chemotherapy had similar disease-free survival outcomes irrespective of whether they received regional nodal radiation.

The low number of recurrence events observed in these patients during the study has led to a reevaluation of the necessity of radiation therapy in this specific subgroup, Haffty says. Historically, radiation therapy has been a standard component of treatment for patients with node-positive breast cancer to reduce the risk of locoregional recurrence. However, Haffty notes that the findings indicating comparable outcomes between patients who received regional nodal radiation therapy and those who did not are influencing clinical practice.

Based off these findings, many radiation oncologists, including Haffty, are now reconsidering the need for regional nodal radiation in these patients, particularly in light of the adverse effects associated with radiation therapy, he says. Despite these promising findings, Haffty acknowledges that some practitioners remain cautious and are waiting for the full publication of the study data before fully integrating this approach into their practice. Nonetheless, the trend toward omitting radiation therapy in patients who convert to node-negative status is gaining traction, as it aligns with a more personalized treatment approach that minimizes unnecessary interventions, Haffty continues.

The omission of radiation therapy in patients with node-positive disease who convert to node-negative status is becoming more common, and this evolving strategy underscores the importance of tailoring treatment plans to an individual patient's response to therapy, Haffty concludes.