Impact of Imaging-Guided Localization on Performance of Tailored Axillary Surgery in Patients with Clinically Node-Positive Breast Cancer: Prospective Cohort Study Within TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101).

Autor: Weber WP; Breast Center, University Hospital Basel, Basel, Switzerland. walter.weber@usb.ch.; University of Basel, Basel, Switzerland. walter.weber@usb.ch., Heidinger M; Breast Center, University Hospital Basel, Basel, Switzerland.; University of Basel, Basel, Switzerland., Hayoz S; SAKK Competence Center, Bern, Switzerland., Matrai Z; Department of Oncoplastic Breast Surgery, Hamad Medical Corporation, Doha, Qatar., Tausch C; University of Basel, Basel, Switzerland.; Breast Center Zurich, Zurich, Switzerland., Henke G; Department of Radiation Oncology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland.; Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland., Zwahlen DR; Department of Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland., Gruber G; Institute of Radiotherapy, Klinik Hirslanden, Zurich, Switzerland., Zimmermann F; University of Basel, Basel, Switzerland.; Clinic of Radiation Oncology, University Hospital Basel, Basel, Switzerland., Montagna G; Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Andreozzi M; Breast Center, University Hospital Basel, Basel, Switzerland.; University of Basel, Basel, Switzerland., Goldschmidt M; Breast Center, University Hospital Basel, Basel, Switzerland.; University of Basel, Basel, Switzerland., Schulz A; University of Basel, Basel, Switzerland.; Department of Clinical Research, University Hospital Basel, Basel, Switzerland., Mueller A; SAKK Competence Center, Bern, Switzerland.; Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland., Ackerknecht M; University of Basel, Basel, Switzerland.; Department of Biomedicine, University Hospital Basel, Basel, Switzerland., Tampaki EC; Department of Plastic, Reconstructive Surgery and Burn Unit, KAT Athens Hospital and Trauma Center, Athens, Greece., Bjelic-Radisic V; Breast Unit, Helios University Clinic, University Witten/Herdecke, Witten, Germany., Kurzeder C; Breast Center, University Hospital Basel, Basel, Switzerland.; University of Basel, Basel, Switzerland., Sávolt Á; National Institute of Oncology, Budapest, Hungary., Smanykó V; National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary., Hagen D; Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland., Müller DJ; Bethesda Spital AG, Basel, Switzerland., Gnant M; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.; ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria., Loibl S; German Breast Group, GBG Forschungs GmbH, Neu-Isenburg, Germany., Fitzal F; ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria.; Atomos Klinik Waehring, Vienna, Austria., Markellou P; Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland., Bekes I; Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland., Egle D; ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria.; Breast Cancer Center Tirol, Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria., Heil J; Breast Center Heidelberg, Heidelberg, Germany., Knauer M; Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Jan; Vol. 31 (1), pp. 344-355. Date of Electronic Publication: 2023 Oct 30.
DOI: 10.1245/s10434-023-14404-4
Abstrakt: Background: Tailored axillary surgery (TAS) is a novel surgical concept for clinical node-positive breast cancer. It consists of the removal of the sentinel lymph nodes (LNs), as well as palpably suspicious nodes. The TAS technique can be utilized in both the upfront and neoadjuvant chemotherapy (NACT) setting. This study assessed whether/how imaging-guided localization (IGL) influenced TAS.
Patients and Methods: This was a prospective observational cohort study preplanned in the randomized phase-III OPBC-03/TAXIS trial. IGL was performed at the surgeon's discretion for targeted removal of LNs during TAS. Immediate back-up axillary lymph node dissection (ALND) followed TAS according to TAXIS randomization.
Results: Five-hundred patients were included from 44 breast centers in six countries, 151 (30.2%) of whom underwent NACT. IGL was performed in 84.4% of all patients, with significant variation by country (77.6-100%, p < 0.001). No difference in the median number of removed (5 vs. 4, p = 0.3) and positive (2 vs. 2, p = 0.6) LNs by use of IGL was noted. The number of LNs removed during TAS with IGL remained stable over time (p = 0.8), but decreased significantly without IGL, from six (IQR 4-6) in 2019 to four (IQR 3-4) in 2022 (p = 0.015). An ALND was performed in 249 patients, removing another 12 (IQR 9-17) LNs, in which a median number of 1 (IQR 0-4) was positive. There was no significant difference in residual nodal disease after TAS with or without IGL (68.0% vs. 57.6%, p = 0.2).
Conclusions: IGL did not significantly change either the performance of TAS or the volume of residual nodal tumor burden.
Trial Registration: ClinicalTrials.gov Identifier: NCT03513614.
(© 2023. The Author(s).)
Databáze: MEDLINE
Externí odkaz: