Cancer Radiother. 2026 Jun 15;30(2):104828. doi: 10.1016/j.canrad.2026.104828. Online ahead of print.
ABSTRACT
PURPOSE: Modern adjuvant therapies, including systemic treatments and radiotherapy, have significantly improved outcomes for patients with breast cancer. However, isolated nodal recurrences remain rare, comprising less than 1 % of cases, and pose a therapeutic challenge, with historical 5-year overall survival rates below 50 %. This study evaluated the clinical outcomes of patients with isolated nodal recurrences in the modern era using the Surveillance, Epidemiology, and End Results (SEER) database and examined factors associated with survival.
MATERIALS AND METHODS: We analysed data from 1479 female patients with cT0N+M0 breast cancer diagnosed between 2000 and 2021 in the SEER database. Patients were categorized as having isolated nodal recurrences if they had prior ipsilateral breast cancer or occult primary breast cancer if presenting with a first cancer diagnosis. Demographics, tumour characteristics, and treatments were recorded. Survival outcomes were assessed using Kaplan-Meier and Cox regression models.
RESULTS: Of 1479 patients, 42 (2.8 %) had isolated nodal recurrences, and 1437 (97.2 %) had occult primary breast cancer. Median time to isolated nodal recurrences was 105 months. Most initial tumours were early-stage (T1-T2, 75 %) and node-negative (78.6 %). Five-year overall- and cancer-specific survival rates of patients with isolated nodal recurrences were 72.4 % (95 % confidence interval [CI]: 57.6-91.0 %) and 81.5 % (95 % CI: 67.8-97.9 %), respectively, compared to 80.4 and 86.6 % for patients with occult primary breast cancer. Trends toward improved survival with adjuvant chemotherapy (5-year overall survival rates: 78.0 versus 68.0 %) and radiotherapy (5-year overall survival rates: 83.6 versus 63.2 %) were observed but not statistically significant. No survival benefit was found for total mastectomy in cases of isolated nodal recurrences following breast-conserving surgery.
CONCLUSION: This study showed encouraging survival outcomes for patients with isolated nodal recurrences in the modern era, with 5-year overall survival exceeding historical benchmarks. Comparable survival between patients with isolated nodal recurrences and occult primary breast cancer highlights the potential for curative approaches. Further research is required to refine treatment strategies and identify patient subgroups that may benefit from tailored therapies.
PMID:42296574 | DOI:10.1016/j.canrad.2026.104828
