# Size matters: a review of the challenges in and importance of multimodal approaches to the management of patients with small, node-negative, triple-negative breast cancer

## TL;DR

This paper reviews the challenges and importance of managing small, node-negative triple-negative breast cancer with multimodal approaches.

## Contribution

The paper provides a focused review on an understudied group of TNBC patients and evaluates current treatment strategies.

## Key findings

- Small node-negative TNBC patients are often excluded from major clinical trials.
- These patients face a higher risk of early relapse compared to hormone receptor-positive patients.
- The paper discusses the benefits of chemotherapy and local therapies for this group.

## Abstract

Patients diagnosed with small (T1a-c) node-negative triple-negative breast cancer (TNBC) comprise an understudied population. These patients have been commonly excluded from participation in large, practice-changing clinical trials that establish improvements in disease-free and overall survival due to neoadjuvant or adjuvant systemic therapies as well as innovative local therapies. Despite this, patients with small, node-negative TNBC are at higher risk for early relapse compared to patients with hormone receptor-positive breast cancer matched for the same T and N stage. We highlight retrospective and prospective studies that analyze the benefit of chemotherapy in small node-negative TNBC patients. Furthermore, we discuss current guidelines for radiation therapy, surgical management, and relevant studies examining local therapy for patients with early-stage node-negative TNBC.