Management of early-stage triple-negative breast cancer: recommendations of a panel of experts from the Brazilian Society of Mastology.

Autor: Freitas-Junior R; Advanced Center for Breast Diagnosis (CORA), Federal University of Goiás and the Araújo Jorge Hospital, Goiás Association for the Combat of Cancer, 1ª Avenida, s/n, Setor Universitário, Goiânia, GO, 74605-050, Brazil. ruffojr@terra.com.br., de Oliveira VM; School of Medical Sciences, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil., Frasson AL; Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (RS), Brazil and the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Cavalcante FP; Fortaleza General Hospital, Fortaleza, CE, Brazil., Mansani FP; Department of Medicine, State University of Ponta Grossa, Ponta Grossa, PR, Brazil., Mattar A; Reference Center in Women's Health Care, Pérola Byington Hospital, São Paulo, SP, Brazil., Zerwes FP; Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil., de Oliveira Freitas AM; Larmony Clinic, Florianópolis, SC, Brazil., de Souza ABA; Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil., Damin AP; Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil., Dos Santos AMR; Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, MG, Brazil., Ruiz CA; Teaching Hospital, School of Medicine, University of São Paulo, São Paulo, SP, Brazil., de Lucena CÊM; Federal University of Minas Gerais, Belo Horizonte, MG, Brazil., Millen EC; Oncoclínicas Institute, Rio de Janeiro, RJ, Brazil., Bagnoli F; School of Medical Sciences, Santa Casa de Misericórdia de São Paulo and the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Andrade F; Department of Breast Surgery, Hospital Sírio-Libanês, São Paulo, SP, Brazil., Rodrigues FLB; Institute of Mastology and Oncology and the Goiania Institute of Hematology (INGOH), Goiânia, GO, Brazil., Facina G; Department of Gynecology, Federal University of São Paulo, São Paulo, SP, Brazil., Novita G; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Pedrini JL; Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil., Guará JP; Teaching Hospital of the Federal University of Maranhão, São Luís, MA, Brazil., Soares LR; Advanced Center for Breast Diagnosis (CORA), Federal University of Goiás and the Dona Iris Women's and Maternity Hospital, Goiânia, GO, Brazil., de Nigro Corpa MV; Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Passos M; Hospital de Base, Federal District, Brasília, DF, Brazil., de Lucena Ferreira NCF; Barão de Lucena Hospital, Federal University of Pernambuco, Recife, PE, Brazil., Freitas NMA; Radiotherapy Unit, Araújo Jorge Cancer Hospital, Goiás Association for the Combat of Cancer, and Brazilian Center for Radiotherapy, Oncology and Mastology (CEBROM), Goiânia, GO, Brazil., Machado RHS; Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brazil., da Cunha Amaral RK; Grupo CAM / Oncoclínicas, Salvador, BA, Brazil., Reinert T; Oncoclínicas Porto Alegre, Porto Alegre (RS) and the Serra Gaúcha Research Center, Caxias do Sul, RS, Brazil., Budel VM; Teaching Hospital of the Federal University of Paraná, Curitiba, PR, Brazil.
Jazyk: angličtina
Zdroj: BMC cancer [BMC Cancer] 2022 Nov 22; Vol. 22 (1), pp. 1201. Date of Electronic Publication: 2022 Nov 22.
DOI: 10.1186/s12885-022-10250-x
Abstrakt: Background: Triple-negative breast cancer (TNBC) is a heterogenous subtype involving different patterns of behavior and clinical course, demanding a complex, individualized sequence of treatment. The knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology regarding TNBC were evaluated and a consensus regarding management and treatment was reached.
Methods: Affiliates completed a survey involving 44 objective questions. In addition, a specialist meeting was held with 27 experts and 3 ad hoc consultants. The panelists completed the survey before and after brainstorming. Answers achieving 70% of agreement were considered consensual. The chi-square test was used to compare answers between panelists and affiliates and the Kappa coefficient to calculate agreement.
Results: Consensus among the panelists increased from 26 (59.1%) to 32 questions (72.7%) following brainstorming (p = 0.17), including 7/10 questions on systemic treatment. Among the affiliates, consensus was achieved for 24 questions (54.5%), resulting in moderate agreement (κ = 0.445). Neoadjuvant chemotherapy should be indicated for almost all cases (except cT1a-b N0) and should include platinum agents. When indicated, immunotherapy is part of the standard of care. The panel reaffirmed the concept of no ink on tumor as indicative of adequate margins and the possibility of sentinel lymph node biopsy for cN1 patients who become cN0 following neoadjuvant therapy. Controversies remain on combining immunotherapy with capecitabine/olaparib in pertinent cases.
Conclusion: Expert consensus was achieved for > 70% of the questions, with moderate agreement between panelists and affiliates. Educational interventions on systemic breast cancer treatment affected decision-making in 60% of the questions.
(© 2022. The Author(s).)
Databáze: MEDLINE
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