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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
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 clinica...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037995/ https://www.ncbi.nlm.nih.gov/pubmed/33805367 http://dx.doi.org/10.3390/cancers13071565 |
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author | Banys-Paluchowski, Maggie Gasparri, Maria Luisa de Boniface, Jana Gentilini, Oreste Stickeler, Elmar Hartmann, Steffi Thill, Marc Rubio, Isabel T. Di Micco, Rosa Bonci, Eduard-Alexandru Niinikoski, Laura Kontos, Michalis Karadeniz Cakmak, Guldeniz Hauptmann, Michael Peintinger, Florentia Pinto, David Matrai, Zoltan Murawa, Dawid Kadayaprath, Geeta Dostalek, Lukas Nina, Helidon Krivorotko, Petr Classe, Jean-Marc Schlichting, Ellen Appelgren, Matilda Paluchowski, Peter Solbach, Christine Blohmer, Jens-Uwe Kühn, Thorsten |
author_facet | Banys-Paluchowski, Maggie Gasparri, Maria Luisa de Boniface, Jana Gentilini, Oreste Stickeler, Elmar Hartmann, Steffi Thill, Marc Rubio, Isabel T. Di Micco, Rosa Bonci, Eduard-Alexandru Niinikoski, Laura Kontos, Michalis Karadeniz Cakmak, Guldeniz Hauptmann, Michael Peintinger, Florentia Pinto, David Matrai, Zoltan Murawa, Dawid Kadayaprath, Geeta Dostalek, Lukas Nina, Helidon Krivorotko, Petr Classe, Jean-Marc Schlichting, Ellen Appelgren, Matilda Paluchowski, Peter Solbach, Christine Blohmer, Jens-Uwe Kühn, Thorsten |
author_sort | Banys-Paluchowski, Maggie |
collection | PubMed |
description | 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. ABSTRACT: 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). |
format | Online Article Text |
id | pubmed-8037995 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-80379952021-04-12 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 Banys-Paluchowski, Maggie Gasparri, Maria Luisa de Boniface, Jana Gentilini, Oreste Stickeler, Elmar Hartmann, Steffi Thill, Marc Rubio, Isabel T. Di Micco, Rosa Bonci, Eduard-Alexandru Niinikoski, Laura Kontos, Michalis Karadeniz Cakmak, Guldeniz Hauptmann, Michael Peintinger, Florentia Pinto, David Matrai, Zoltan Murawa, Dawid Kadayaprath, Geeta Dostalek, Lukas Nina, Helidon Krivorotko, Petr Classe, Jean-Marc Schlichting, Ellen Appelgren, Matilda Paluchowski, Peter Solbach, Christine Blohmer, Jens-Uwe Kühn, Thorsten Cancers (Basel) Review 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. ABSTRACT: 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). MDPI 2021-03-29 /pmc/articles/PMC8037995/ /pubmed/33805367 http://dx.doi.org/10.3390/cancers13071565 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ). |
spellingShingle | Review Banys-Paluchowski, Maggie Gasparri, Maria Luisa de Boniface, Jana Gentilini, Oreste Stickeler, Elmar Hartmann, Steffi Thill, Marc Rubio, Isabel T. Di Micco, Rosa Bonci, Eduard-Alexandru Niinikoski, Laura Kontos, Michalis Karadeniz Cakmak, Guldeniz Hauptmann, Michael Peintinger, Florentia Pinto, David Matrai, Zoltan Murawa, Dawid Kadayaprath, Geeta Dostalek, Lukas Nina, Helidon Krivorotko, Petr Classe, Jean-Marc Schlichting, Ellen Appelgren, Matilda Paluchowski, Peter Solbach, Christine Blohmer, Jens-Uwe Kühn, Thorsten 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 |
title | 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 |
title_full | 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 |
title_fullStr | 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 |
title_full_unstemmed | 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 |
title_short | 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 |
title_sort | 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 |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037995/ https://www.ncbi.nlm.nih.gov/pubmed/33805367 http://dx.doi.org/10.3390/cancers13071565 |
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