Sentinel node-guided radiotherapy in Japanese patients with early-stage breast cancer: a single-institution experience with partial-breast brachytherapy and regional nodal irradiation.

Introduction: Breast-conserving therapy involves breast-conserving surgery (BCS) with sentinel node (SN) biopsy, followed by whole-breast irradiation (WBI). As a de-escalating strategy, partial-breast irradiation (PBI) has been implemented in SN-negative patients. In contrast, postoperative WBI with regional nodal irradiation (RNI) has replaced axillary clearance in SN-positive patients. This study evaluates the oncological outcomes of these SN-based strategies in Japanese patients.

Patients and methods: This retrospective study included clinical node-negative patients who underwent BCS with SN biopsy between January 2016 and November 2024. Perioperative PBI using multicatheter interstitial brachytherapy (MIB) was administered to patients with pN0(sn) or pN1mi(sn) disease, whereas WBI with RNI was administered to those with pN+(sn) disease. Oncological outcomes were assessed based on locoregional recurrence (LRR), distant recurrence (DR), and overall survival (OS).

Results: Among 828 patients, 694 (83.8%) received MIB-PBI and 134 (16.2%) underwent WBI alone. Based on SN status, 649 (78.4%) patients received MIB-PBI, 114 (13.8%) underwent WBI alone, and 65 (7.8%) underwent WBI with RNI. After a median follow-up of 54 months, there was no significant difference in 5-year LRR-free survival (97.5% vs 97.1% vs 97.0%; p = 0.78); however, significant differences were observed in DR-free (99.6% vs 98.4% vs 93.6%; p < 0.001) and OS (99.4% vs 98.4% vs 93.6%; p < 0.001) among the MIB-PBI, WBI alone, and WBI with RNI groups, respectively.

Discussion: Despite the limitations of a retrospective design, a small sample size, and a relatively short follow-up period, SN-based de-escalating strategies, including perioperative MIB-PBI and RNI, demonstrated favorable oncological outcomes.