National trends in dual de-escalation of axillary surgery and adjuvant radiation in early-stage HR+/HER2- breast cancer.
5 affiliations
- 1Division of Breast Surgery, Department of Surgery, Fox Chase Cancer Center, 333 Cottman Ave, c308, Philadelphia, PA, 19111, USA.
- 2Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
- 3Research Institute, Endeavor Health, Evanston, IL, USA.
- 4Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
- 5Division of Breast Surgery, Department of Surgery, Fox Chase Cancer Center, 333 Cottman Ave, c308, Philadelphia, PA, 19111, USA. [email protected].
Abstract
Purpose
De-escalation has become standard across breast cancer management. Many early-stage HR+/HER2-negative breast cancers are eligible for both SLNB omission and accelerated partial breast irradiation (APBI). However, the oncologic safety of dual de-escalation has not been evaluated except in patients ≥ 70 years. We sought to characterize national practice patterns and factors associated with adoption of this dual de-escalation approach.Methods
Women aged 50-69 years with clinical T1-T2N0 breast cancer who underwent upfront breast-conserving surgery between (2012 - 2022) were identified from the National Cancer Database. Patients were categorized by axillary surgery and by adjuvant radiation modality (WBI, APBI, or none). We assessed trends and factors associated with de-escalation.Results
316,324 patients met inclusion criteria, of whom 98% underwent SLNB. Among patients who underwent SLNB, 83% received WBI, 11% received APBI, and 6% received no radiation. In contrast, among patients in whom SLNB was omitted, 63% received WBI, 8% received APBI, and 30% received no radiation. SLNB omission remained low throughout the study period at < 3%, while APBI use increased from 8% to 16.5%. Dual de-escalation was rarely performed throughout the study period remaining < 0.30%. Shared predictors of de-escalation included cT1 tumors, ductal histology, low grade, and treatment at academic/research programs.Conclusion
These findings highlight the need for prospective studies to define the safety, outcomes, and patient selection criteria for combined de-escalation strategies. Until these data are available, patient-centered discussions are essential to determine the most appropriate strategy for patients with low-risk disease.
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BibTeX
@article{brokaw2026national,
title = {{National trends in dual de-escalation of axillary surgery and adjuvant radiation in early-stage HR+/HER2- breast cancer.}},
author = {Dylan S Brokaw and Leonardo Kozian and Cecilia Chang and Rebecca M Shulman and Richard J Bleicher and Alycia So and Allison A Aggon and Austin D Williams},
journal = {Breast cancer research and treatment},
year = {2026},
month = oct,
doi = {10.1007/s10549-026-08106-0},
url = {https://europepmc.org/article/MED/42894070},
note = {CC BY},
}
RIS
TY - JOUR
TI - National trends in dual de-escalation of axillary surgery and adjuvant radiation in early-stage HR+/HER2- breast cancer.
AU - Dylan S Brokaw
AU - Leonardo Kozian
AU - Cecilia Chang
AU - Rebecca M Shulman
AU - Richard J Bleicher
AU - Alycia So
AU - Allison A Aggon
AU - Austin D Williams
PY - 2026
DA - 2026/10/18
JO - Breast cancer research and treatment
DO - 10.1007/s10549-026-08106-0
UR - https://europepmc.org/article/MED/42894070
AB - Purpose De-escalation has become standard across breast cancer management. Many early-stage HR+/HER2-negative breast cancers are eligible for both SLNB omission and accelerated partial breast irradiation (APBI). However, the oncologic safety of dual de-escalation has not been evaluated except in patients ≥ 70 years. We sought to characterize national practice patterns and factors associated with adoption of this dual de-escalation approach.Methods Women aged 50-69 years with clinical T1-T2N0 breast cancer who underwent upfront breast-conserving surgery between (2012 - 2022) were identified from the National Cancer Database. Patients were categorized by axillary surgery and by adjuvant radiation modality (WBI, APBI, or none). We assessed trends and factors associated with de-escalation.Results 316,324 patients met inclusion criteria, of whom 98% underwent SLNB. Among patients who underwent SLNB, 83% received WBI, 11% received APBI, and 6% received no radiation. In contrast, among patients in whom SLNB was omitted, 63% received WBI, 8% received APBI, and 30% received no radiation. SLNB omission remained low throughout the study period at < 3%, while APBI use increased from 8% to 16.5%. Dual de-escalation was rarely performed throughout the study period remaining < 0.30%. Shared predictors of de-escalation included cT1 tumors, ductal histology, low grade, and treatment at academic/research programs.Conclusion These findings highlight the need for prospective studies to define the safety, outcomes, and patient selection criteria for combined de-escalation strategies. Until these data are available, patient-centered discussions are essential to determine the most appropriate strategy for patients with low-risk disease.
SN - 0167-6806
SN - 1573-7217
ER -