AXSANA (Axillary Surgery After Neoadjuvant Treatment): A European prospective multicenter cohort study to evaluate different surgical methods of axillary staging (sentinel lymph node biopsy, targeted axillary dissection, axillary dissection) in clinically node-positive breast cancer patients treated with neoadjuvant chemotherapy: preliminary data

Introduction Surgical treatment of the axilla in cN+→ycN0 patients after neoadjuvant chemotherapy is controversial. Various techniques (ALND=Axillary Lymph Node Dissection, TAD=Targeted Axillary Dissection, TLNB=Target Lymph Node Biopsy and SLNB=Sentinel Lymph Node Biopsy) are used but comparative data on outcome/morbidity of these procedures are not available.

Methods AXSANA is an international prospective cohort study initiated by EUBREAST and funded by AGO-B, Claudia von Schilling Foundation,AWOgyn, EndoMag,MeritMedical and Mammotome, and supported by NOGGO and GBG. Primary aims are invasive disease-free survival, axillary recurrence rate and quality of life in cN+→ycN0 patients treated with different staging techniques.

Results So far, 350 cN+ patients from nine countries were recruited. Nodes were suspicious upon clinical examination and imaging in 71 % and imaging only in 29 % of patients. 19 % of patients had ≥ 4 suspicious lymph nodes. In 66 % of cases, ≥ 1 target node was marked (1 node in 92 %, 2 nodes in 7 %, ≥ 3 nodes in 1 %). Clip/coil was used in 75 % of patients, followed by carbon ink (15 %) and magnetic seed (10 %). 75 % of patients converted to ycN0. TAD was planned in 51 %, ALND in 37 %,SLNB in 10 % and TLNB in 1 % of patients. 63 % of study sites choosing TAD reported to have performed ≥ 30 procedures. Among patients receiving preoperative target node localization, most(76 %) underwent wire-guided localization.

Conclusions Our preliminary data show that axillary staging is very heterogenous among countries. TAD is widely used despite lack of long-term oncological data. Final results of AXSANA will contribute to clarify the oncological safety of axillary surgical de-escalation.

Interessenkonflikt

Maggie Banys-Paluchowski received honoraria for lectures and participation in advisory boards from: Roche, Novartis, Pfizer, Eli Lilly, Eisai, and AstraZeneca Marc Thill 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, AstraZeneca, 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-Institute, Lilly, MCI, Medtronic, MSD, Novartis, onkowissen.de, Omniamed, Pfizer, pfm medical, Roche, RTI Surgical, Sysmex, Vifor; trial funding from: Endomag, Exact Sciences.

Publication History

Article published online:
01 June 2021