Деэскалация лучевой терапии у больных раком молочной железы с полным патоморфологическим ответом в лимфатических узлах: систематический обзор

De-escalation of Radiotherapy in Breast Cancer Patients with Nodal pCR: A Systematic Review of the Literature

Introduction. Regional nodal irradiation in breast cancer carries a significant risk of adverse effects, including lymph-edema, while overtreatment may lead to substantial morbidity without demonstrable improvement in oncologic outcomes. Although preliminary 5-year data from recent prospective trials suggest radiotherapy de-escalation maintains oncologic safety, conflicting evidence from other studies has prevented the establishment of international consensus on this therapeutic approach. Aim. To identify breast cancer patient cohorts for whom radiotherapy de-escalation may represent an oncologically safe approach following neoadjuvant chemotherapy and achievement of pathological complete response (pCR) in regional lymph nodes. Materials and Methods. We conducted a systematic analysis of both retrospective and prospective studies comparing outcomes between breast cancer patients who did or did not receive regional nodal irradiation following neoadjuvant chemotherapy with subsequent pCR in lymph nodes. The literature search was performed using PubMed database with the following breast cancer, regional lymph node irradiation, pathological complete response, and radiotherapy de-escalation. Results. Our systematic review incorporated data from 28 published studies. In most studies, an improvement in overall survival and/or locoregional control was found only in the presence of additional risk factors: advanced clinical stage, hormone receptor negativity. Notably, one study reported enhanced locoregional control specifically in patients with luminal subtypes, while another publication documented a significant overall survival benefit from regional nodal irradiation in cases demonstrating pCR in the lymph nodes without concurrent pCR in the primary tumor. Preliminary findings from the prospective NSABP B-51 prospective study indicate no survival benefit from regional nodal irradiation in patients who initially presented with limited nodal involvement and subsequently achieved nodal pCR. Conclusion. Given the pending long-term results from the NSABP B-51 prospective study and conflicting retrospective data, radiation therapy should currently be administered according to the initial clinical stage and current clinical guidelines. © (2025), (Autonomous non-profit scientific and medical organization). All rights reserved.