ArticleBreast cancer research and treatment2026
Retrospective study on regional nodal irradiation after omission of axillary lymph node dissection in sentinel lymph node-positive breast cancer: a propensity score matching analysis.
Article in Breast cancer research and treatment, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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5 authors.
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Abstract
BACKGROUND AND
objectivesWith the de-escalation of axillary surgery in early breast cancer, sentinel lymph node biopsy (SLNB) has largely replaced axillary lymph node dissection (ALND) for patients with limited nodal disease. However, whether regional nodal irradiation (RNI) is necessary for SLN-positive patients who forgo ALND remains controversial. This study aimed to evaluate the clinical value of RNI in such patients.
methodsWe conducted a retrospective, multi-center study of early breast cancer patients with positive SLNs who did not undergo ALND between February 2011 and February 2021. Patients were divided into an RNI group and a no-RNI group based on whether postoperative radiotherapy included regional nodal fields. Propensity score matching (PSM) was used to balance baseline characteristics. Survival outcomes were compared using Kaplan-Meier curves and Cox regression.
resultsAmong 8328 screened patients, 356 met the inclusion criteria. After PSM, 151 matched pairs were analyzed. The RNI group showed significantly better disease-free survival (DFS) than the no-RNI group (92.5% vs. 83.0%, P = 0.031), while overall survival (OS) did not differ significantly (92.5% vs. 86.8%, P = 0.168). Multivariate analysis confirmed that omitting RNI was an independent risk factor for worse DFS (HR = 2.387, 95% CI: 1.154-4.938, P = 0.019). Subgroup analyses revealed that the DFS benefit of RNI was particularly evident in patients with T2-3 tumors or more than one metastatic SLN.
conclusionFor SLN-positive breast cancer patients who omit ALND, the addition of RNI is associated with improved DFS, especially in those with higher T stage or multiple SLN metastases. These findings suggest that RNI was associated with improved DFS in higher-risk patients and may be considered in this subset, although confirmation in prospective studies is needed.
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