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 recom-mendations. 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, re-placing 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).
| Originalsprache | Englisch |
|---|---|
| Aufsatznummer | 1565 |
| Zeitschrift | Cancers |
| Jahrgang | 13 |
| Ausgabenummer | 7 |
| ISSN | 2072-6694 |
| DOIs | |
| Publikationsstatus | Veröffentlicht - 01.04.2021 |
Fördermittel
AXSANA, initiated by EUBREAST (http://axsana.eubreast.com; accessed on 27 March 2021, Figure 1), is a large, prospective, non‐interventional cohort study aiming to evaluate the role of axillary treatment in cN+ patients undergoing NACT. With a target accrual of 3000 patients, the study is expected to be able to resolve several open issues. Patients with clinically positive nodal status at time of diagnosis who are scheduled to receive axillary surgery after NACT can be enrolled. Axillary staging procedures and treatment modalities are chosen at the discretion of the treating physicians and according to national and institutional guidelines. Inclusion and exclusion criteria are presented in Table 8. Follow‐up is annually during the first five years after surgery. Arm morbidity and quality of life are evaluated at baseline and after 1, 3, and 5 years, using four validated questionnaires (EORTC QLQ‐C 30, EORTC QLQ BR 23, Lymph‐ICF, and Sense of Coher‐ ence). Financial support has been provided by the AGO‐B study group, the AWOgyn (German Working Group for Reconstructive Surgery in Oncology‐Gynecology), Claudia von Schilling Foundation for Breast Cancer Research, EndoMag, Mammotome, and Mer‐ itMedical. AXSANA is further supported by the North‐Eastern German Society of Gyne‐ cological Oncology (NOGGO) and the German Breast Group (GBG). Conflicts of Interest: The AXSANA study has received financial support from EndoMag, Mam‐ motome. and MeritMedical. The funding sources had no role in the design of the study and will not have any role during analysis and interpretation of the data, or decision to submit results. M.B.P. received honoraria for lectures and participation in advisory boards from: Roche, Novartis, Pfizer, Eli Lilly, Eisai, and AstraZeneca. M.T. received honoraria for participation in advisory boards from: Amgen, AstraZeneca, Biom‘Up, Celgene, ClearCut, Clovis, Daiichi Sankyo, Eisai, Exact Sciences, GSK, Lilly, MSD, Norgine, Neodynamics, Novartis, onkowissen.de, Pfizer, pfm medical, Pierre‐Fabre, Roche, RTI Surgical, Sysmex, Tesaro; manuscript support from: Amgen, Celgene, Clearcut, pfm medical, Roche; travel reimbursement from: Amgen, Art Tempi, Astra‐ Zeneca, Celgene, Clovis, Connect Medica, Daiichi Sankyo, Eisai, Exact Sciences, Hexal, I‐Med‐ Institute, Lilly, MCI, Medtronic, MSD, Norgine, Novartis, Omniamed, Pfizer, pfm Medical, Roche, RTI Surgical, Tesaro; congress support: Amgen, AstraZeneca, Celgene, Daiichi Sanyko, Hexal, Novartis, Pfizer, Roche; honoraria for lectures from: Amgen, Art Tempi, AstraZeneca, Celgene, Clovis, Connect Medica, Daiichi Sankyo, Eisai, Exact Sciences, Gedeon Richter, Hexal, I‐Med‐Insti‐ tute, Lilly, MCI, Medtronic, MSD, Novartis, onkowissen.de, Omniamed, Pfizer, pfm medical, Roche, RTI Surgical, Sysmex, Vifor; trial funding from: Endomag, Exact Sciences. Other authors declare no conflicts of interest.
Strategische Forschungsbereiche und Zentren
- Zentren: Universitäres Cancer Center Schleswig-Holstein (UCCSH)
- Profilbereich: Lübeck Integrated Oncology Network (LION)
DFG-Fachsystematik
- 2.22-14 Hämatologie, Onkologie
- 2.22-21 Gynäkologie und Geburtshilfe
UN SDGs
Dieser Output leistet einen Beitrag zu folgendem(n) Ziel(en) für nachhaltige Entwicklung
