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01-03-2020 | Mastectomy | Correspondence

De-escalation treatment of axilla in breast cancer

Authors: G. Corso, V. Galimberti, P. Veronesi

Published in: Clinical and Translational Oncology | Issue 3/2020

Excerpt

In cases of negative axillary staging, axillary lymph node dissection (ALND) has been replaced by sentinel node (SN) biopsy as the standard treatment for BC. ALND following a positive SN biopsy is being progressively abandoned. Results from the latest 10 years, phase 3 trial (IBCSG 23-01) confirmed that if the SN displays only micrometastases, then ALND is not indicated [1]. However, ALND is routinely performed in cases of macrometastatic SN biopsy, in particular after mastectomy. In breast-conserving surgery (BCS), results from the ACOSOG Z0011 trial contraindicated ALND if only one to two SNs are positive. ALND is still recommended if ≥ 3 SNs contain metastases or macroscopic lymph node is found intraoperatively [2]. …

Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol. 2018;19(10):1385–93. https://doi.org/10.1016/S1470-2045(18)30380-2.CrossRefPubMed

Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA. 2017;318(10):918–26. https://doi.org/10.1001/jama.2017.11470.CrossRefPubMedPubMedCentral

Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303–10. https://doi.org/10.1016/S1470-2045(14)70460-7.CrossRefPubMedPubMedCentral

Gentilini O, Botteri E, Dadda P, et al. Physical function of the upper limb after breast cancer surgery. Results from the SOUND (Sentinel node vs. Observation after axillary Ultra-souND) trial. Eur J Surg Oncol. 2016;42(5):685–9. https://doi.org/10.1016/j.ejso.2016.01.020.CrossRefPubMed

de Boniface J, Frisell J, Andersson Y, et al. Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection: the randomized controlled SENOMAC trial. BMC Cancer. 2017;17(1):379. https://doi.org/10.1186/s12885-017-3361-y.CrossRefPubMedPubMedCentral

Title: De-escalation treatment of axilla in breast cancer
Authors: G. Corso
V. Galimberti
P. Veronesi
Publication date: 01-03-2020
Publisher: Springer International Publishing
Keyword: Mastectomy
Published in: Clinical and Translational Oncology / Issue 3/2020
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI: https://doi.org/10.1007/s12094-019-02129-4

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