Τίτλος:
Surgical Management of the Axilla in Clinically Node-Positive Breast
Cancer Patients Converting to Clinical Node Negativity through
Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale
for the EUBREAST-03 AXSANA Study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Simple Summary
Currently, it is unclear which kind of axillary staging surgery breast
cancer patients with lymph node metastasis should receive after
neoadjuvant chemotherapy. For decades, these patients have been treated
with a full axillary lymph node dissection, even if they converted to
clinical node negativity. However, the removal of a large number of
lymph nodes during the procedure can increase arm morbidity and impact
quality of life. Therefore, several studies investigated less radical
surgical strategies in this setting, such as sentinel lymph node biopsy
or targeted axillary dissection, i.e., removal of a previously marked
node combined with sentinel node removal. In this review, we summarize
current evidence on the different surgical techniques and compare
national and international recommendations. We show that many questions
regarding oncological safety of different surgery types and the optimal
marking technique remain unanswered and present the multinational
prospective cohort study AXSANA that will address these open issues.
In the last two decades, surgical methods for axillary staging in breast
cancer patients have become less extensive, and full axillary lymph node
dissection (ALND) is confined to selected patients. In initially
node-positive patients undergoing neoadjuvant chemotherapy, however, the
optimal management remains unclear. Current guidelines vary widely,
endorsing different strategies. We performed a literature review on
axillary staging strategies and their place in international
recommendations. This overview defines knowledge gaps associated with
specific procedures, summarizes currently ongoing clinical trials that
address these unsolved issues, and provides the rationale for further
research. While some guidelines have already implemented surgical
de-escalation, replacing ALND with, e.g., sentinel lymph node biopsy
(SLNB) or targeted axillary dissection (TAD) in cN+ patients converting
to clinical node negativity, others recommend ALND. Numerous techniques
are in use for tagging lymph node metastasis, but many questions
regarding the marking technique, i.e., the optimal time for marker
placement and the number of marked nodes, remain unanswered. The optimal
number of SLNs to be excised also remains a matter of debate. Data on
oncological safety and quality of life following different staging
procedures are lacking. These results provide the rationale for the
multinational prospective cohort study AXSANA initiated by EUBREAST,
which started enrollment in June 2020 and aims at recruiting 3000
patients in 20 countries (NCT04373655; Funded by AGO-B, Claudia von
Schilling Foundation for Breast Cancer Research, AWOgyn, EndoMag,
Mammotome, and MeritMedical).
Συγγραφείς:
Banys-Paluchowski, Maggie
Gasparri, Maria Luisa
de Boniface,
Jana
Gentilini, Oreste
Stickeler, Elmar
Hartmann, Steffi and
Thill, Marc
Rubio, Isabel T.
Di Micco, Rosa
Bonci,
Eduard-Alexandru
Niinikoski, Laura
Kontos, Michalis and
Karadeniz Cakmak, Guldeniz
Hauptmann, Michael
Peintinger,
Florentia
Pinto, David
Matrai, Zoltan
Murawa, Dawid and
Kadayaprath, Geeta
Dostalek, Lukas
Nina, Helidon
Krivorotko,
Petr
Classe, Jean-Marc
Schlichting, Ellen
Appelgren, Matilda
and Paluchowski, Peter
Solbach, Christine
Blohmer, Jens-Uwe and
Kuehn, Thorsten
AXSANA Study Grp
Λέξεις-κλειδιά:
neoadjuvant therapy; breast cancer; therapy response; targeted axillary
dissection; marked lymph node
DOI:
10.3390/cancers13071565
