RSS-Feed abonnieren
DOI: 10.1055/a-1889-7883
Axillary Staging after Neoadjuvant Chemotherapy for Initially Node-Positive Breast Carcinoma in Germany
Initial Data from the AXSANA study Artikel in mehreren Sprachen: English | deutsch
Abstract
Introduction To date, the optimal axillary staging procedure for initially node-positive breast carcinoma patients after neoadjuvant chemotherapy (NACT) has been unclear. The aim of the AXSANA study is to prospectively compare different surgical staging techniques with respect to the oncological outcome and quality of life for the patients. Little is known about current clinical practice in Germany.
Material and Methods In this paper we analyzed data from patients enrolled in the AXSANA study at German study sites from June 2020 to March 2022.
Results During the period under investigation, 1135 patients were recruited at 143 study sites. More than three suspicious lymph nodes were initially found in 22% of patients. The target lymph node (TLN) was marked in 64% of cases. This was done with clips/coils in 83% of patients, with magnetic seeds or carbon suspension in 8% each, and with a radar marker in 1% of patients. After NACT, targeted axillary dissection (TAD) or axillary lymphadenectomy (ALND) were each planned in 48% of patients, and sentinel lymph node biopsy alone (SLNB) in 2%. Clinically, the nodal status after NACT was found to be unremarkable in 65% of cases. Histological lymph node status was correctly assessed by palpation in 65% of patients and by sonography in 69% of patients.
Conclusion At the German AXSANA study sites, TAD and ALND are currently used as the most common surgical staging procedures after NACT in initially node-positive breast cancer patients. The TLN is marked with various markers prior to NACT. Given the inadequate accuracy of clinical assessment of axillary lymph node status after NACT, it should be questioned whether axillary dissection after NACT should be performed based on clinical assessment of nodal status alone.
Key words
breast carcinoma - neoadjuvant chemotherapy - AXSANA - targeted axillary dissection - target lymph nodesPublikationsverlauf
Eingereicht: 15. November 2021
Angenommen nach Revision: 30. Juni 2022
Artikel online veröffentlicht:
13. September 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References/Literatur
- 1 Riedel F, Hoffmann AS, Moderow M. et al. Time trends of neoadjuvant chemotherapy for early breast cancer. Int J Cancer 2020; 147: 3049-3058
- 2 Morrow M, Khan AJ. Locoregional Management After Neoadjuvant Chemotherapy. J Clin Oncol 2020; 38: 2281-2289
- 3 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). Interdisziplinäre S3-Leitlinie für die Früherkennung, Diagnostik, Therapie und Nachsorge des Mammakarzinoms. Accessed March 20, 2022 at: https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Mammakarzinom_4_0/Version_4.4/LL_Mammakarzinom_Langversion_4.4.pdf
- 4 Arbeitsgemeinschaft Gynäkologische Onkologie e.V. Kommission Mamma. Accessed May 30, 2022 at: https://www.ago-online.de/fileadmin/ago-online/downloads/_leitlinien/kommission_mamma/2022/Einzeldateien/AGO_2022D_08_Operative_Therapie_des_MaCa_onkl_Aspekte.pdf
- 5 Simons JM, van Nijnatten TJA, van der Pol CC. et al. Diagnostic Accuracy of Different Surgical Procedures for Axillary Staging After Neoadjuvant Systemic Therapy in Node-positive Breast Cancer: A Systematic Review and Meta-analysis. Ann Surg 2019; 269: 432-442
- 6 Caudle AS, Yang WT, Krishnamurthy S. et al. Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection. J Clin Oncol 2016; 34: 1072-1078
- 7 Kuemmel S, Heil J, Rueland A. et al. A Prospective, Multicenter Registry Study to Evaluate the Clinical Feasibility of Targeted Axillary Dissection (TAD) in Node-Positive Breast Cancer Patients. Ann Surg 2020;
- 8 Simons J, van Nijnatten TJA, Koppert LB. et al. Abstract GS1-10: Radioactive Iodine Seed placement in the Axilla with Sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer: Results of the prospective multicenter RISAS trial. Cancer Res 2021; 81 (4_Supplement): GS1: 10
- 9 Samiei S, Simons JM, Engelen SME. et al. Axillary Pathologic Complete Response After Neoadjuvant Systemic Therapy by Breast Cancer Subtype in Patients With Initially Clinically Node-Positive Disease: A Systematic Review and Meta-analysis. JAMA Surg 2021;
- 10 Liedtke C, Thill M. AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2016. Breast Care (Basel) 2016; 11: 204-214
- 11 Ditsch N, Untch M, Thill M. et al. AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2019. Breast Care (Basel) 2019; 14: 224-245
- 12 Kuehn T, de Boniface J, Gentilini O. et al. AXSANA-Protokoll Version 5.1, 07.01.2021. Accessed March 20, 2022 at: https://www.eubreast.com/userfiles/downloads/axsana/AXSANA_Protokoll_Deutsch_Version_5.1.pdf
- 13 ClinicalTrials.gov. AXillary Surgery After NeoAdjuvant Treatment (AXSANA). Accessed March 20, 2022 at: https://clinicaltrials.gov/ct2/show/NCT04373655
- 14 Donker M, Straver ME, Wesseling J. et al. Marking axillary lymph nodes with radioactive iodine seeds for axillary staging after neoadjuvant systemic treatment in breast cancer patients: the MARI procedure. Ann Surg 2015; 261: 378-382
- 15 Samiei S, de Mooij CM, Lobbes MBI. et al. Diagnostic Performance of Noninvasive Imaging for Assessment of Axillary Response After Neoadjuvant Systemic Therapy in Clinically Node-positive Breast Cancer: A Systematic Review and Meta-analysis. Ann Surg 2021; 273: 694-700
- 16 Banys-Paluchowski M, Gruber IV, Hartkopf A. et al. Axillary ultrasound for prediction of response to neoadjuvant therapy in the context of surgical strategies to axillary dissection in primary breast cancer: a systematic review of the current literature. Arch Gynecol Obstet 2020; 301: 341-353
- 17 Kuehn T, Bauerfeind I, Fehm T. et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol 2013; 14: 609-618
- 18 Boughey JC, Suman VJ, Mittendorf EA. et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 2013; 310: 1455-1461
- 19 Friedrich M, Kuehn T, Janni W. et al. AGO recommendations for the surgical therapy of the axilla after neoadjuvant chemotherapy: 2021 Update. Geburtshilfe Frauenheilkd 2021; 81: 1112-1120
- 20 Banys-Paluchowski M, Gasparri ML, de Boniface J. et al. The Axsana Study Group. 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. Cancers (Basel) 2021; 13: 1565
- 21 Hartmann S, Stachs A, Kühn T. et al. Targeted Removal of Axillary Lymph Nodes After Carbon Marking in Patients with Breast Cancer Treated with Primary Chemotherapy. Geburtshilfe Frauenheilkd 2021; 81: 1121-1127
- 22 Hartmann S, Kühn T, de Boniface J. et al. Carbon tattooing for targeted lymph node biopsy after primary systemic therapy in breast cancer: prospective multicentre TATTOO trial. Br J Surg 2021; 108: 302-307