Post SABCS local therapy and radiology

Summary

This year there were three interesting oral presentations and several posters presenting important new data regarding local therapy (surgery and radiotherapy) as well as radiological aspects. This minireview is a personal view of the clinically most relevant data in this respect with the following conclusions: A micrometastasis is no indication for axillary dissection. The number of involved sentinel lymph nodes predicts non-sentinel lymph node metastasis and should be taken into account regarding omitting axillary dissection. Neoadjuvant chemotherapy reduces the risk of non-sentinel lymph node metastasis. A 2 mm margin shows an optimal rate of local recurrences after breast conservation. The question of the correct definition for an R0 resection after neoadjuvant therapy remains open. We should omit radiotherapy for women with low risk ductal carcinoma in situ (DCIS) below 2.5 cm in size and pT1a G1 after breast conservation. Risk of finding invasive cancer after having a B3 biopsy is very low depending on the type of lesion, thus, questioning the surgical approach of some of these entities. The use of magnetic resonance imaging is a standard procedure before and after neoadjuvant therapy. Data regarding correlation between complete radiologic response (rCR) with pathologic complete response (pCR) and real tumor size are rare. For women with micrometastases or isolated tumor cells in the sentinel node postmastectomy radiotherapy has little benefit. After neoadjuvant therapy only women with ypN2 had a significant benefit of postmastectomy radiotherapy for local, disease-free and overall survival.

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