new rx because of isolated tumor cells

Barbe,  Here is a copy of the article I showed her.  

Study Highlights Prognostic Importance of Isolated Tumor Cells in Sentinel Nodes
Elsevier Global Medical News. 2009 Jan 27, B Jancin


SAN ANTONIO (EGMN) - The presence of isolated tumor cells or micrometastases in sentinel lymph nodes of breast cancer patients who don't receive adjuvant systemic therapy is associated with an absolute 9% worse rate of 5-year disease-free survival, compared with that in women with clear sentinel nodes, according to the large observational Dutch MIRROR study.

On a positive note, MIRROR participants with isolated tumor cells (ITCs) or micrometastases in sentinel nodes did benefit from adjuvant systemic endocrine therapy and/or chemotherapy, Dr. Maaike de Boer reported at the San Antonio Breast Cancer Symposium.

MIRROR is the acronym for a nationwide Dutch study provocatively titled Micrometastases and Isolated Tumor Cells: Relevant and Robust or Rubbish? The key preliminary finding is that ITCs and micrometastases are indeed clinically relevant and robust prognostic indicators; moreover, their associated risk is modified by adjuvant systemic therapy, added Dr. de Boer of Maastricht (the Netherlands) University Medical Center.

MIRROR included 2,628 Netherlands Cancer Registry patients with invasive breast cancer, all with relatively favorable primary tumor characteristics, who underwent sentinel lymph node biopsy. They were classified into three groups: 838 women with negative sentinel nodes who received no adjuvant systemic therapy; 832 with ITCs or micrometastases who had no adjuvant systemic therapy; and 958 with ITCs or micrometastases who did receive adjuvant therapy. ITCs are defined as metastatic sentinel lymph node deposits 0.2 mm in size or less, while micrometastases are larger deposits of up to 2.0 mm.

This observational study was possible because the relatively conservative 2002 Dutch cancer guidelines in place during the study period stated that no consensus existed regarding adjuvant therapy in the setting of grades I or II tumors 1-3 cm in size, or in smaller tumors regardless of grade. The guidelines left the decision as to whether to prescribe adjuvant systemic therapy up to individual physicians and their patients at a time when the prevailing Dutch physician practice was evenly split.

Among MIRROR subjects who didn't receive adjuvant systemic therapy, 5-year disease-free survival was 85.7% in those with negative sentinel nodes, significantly better than the 77.2% rate in patients with ITCs and the 76.4% rate in those with micrometastases (P = .003).

In a multivariate analysis controlling for age, tumor size, grade, and hormone receptor status, the presence of micrometastases was independently associated with a 50% increase in the risk of recurrent disease. To the investigators' surprise, the risk associated with ITCs proved equally large, Dr. de Boer noted.

The 5-year disease-free survival was 83% in patients with sentinel node ITCs who received adjuvant systemic therapy, an absolute 5.8% improvement over the rate in those who didn't. Five-year disease-free survival in patients with sentinel node micrometastases who got adjuvant systemic therapy was 88%, an absolute 11.6% better than in those who did not.

In a multivariate analysis controlling for known prognostic factors and axillary dissection, adjuvant systemic therapy was associated with a 33% reduction in the risk of disease recurrence in women with sentinel node ITCs and a 50% risk reduction in women with micrometastases, according to Dr. de Boer.

MIRROR was funded by the Netherlands Organization for Health Research and Development and supported by the Dutch Breast Cancer Trialists Group.