Oncologic outcomes of de-escalating axillary treatment in clinically node-positive breast cancer patients treated with neoadjuvant systemic therapy - A two center cohort study.

Autor: Schipper RJ; Department of Surgery, Catharina Hospital Eindhoven, the Netherlands; Department of Surgery, Anna Hospital, Geldrop, the Netherlands. Electronic address: info@rjschipper.nl., de Bruijn A; Department of Surgery, Catharina Hospital Eindhoven, the Netherlands., van der Sangen MJC; Department of Radiotherapy, Catharina Hospital Eindhoven, the Netherlands., Bloemen JG; Department of Surgery, Catharina Hospital Eindhoven, the Netherlands., van den Hoven I; Department of Surgery, Anna Hospital, Geldrop, the Netherlands., Schepers EEM; Department of Surgery, Anna Hospital, Geldrop, the Netherlands., Vriens BEP; Department of Internal Medicine, Catharina Hospital Eindhoven, the Netherlands., Boerman T; Department of Pathology, Eurofins PAMM, Veldhoven, the Netherlands., Rijkaart DC; Department of Radiotherapy, Catharina Hospital Eindhoven, the Netherlands., van de Winkel LMH; Department of Internal Medicine, Anna Hospital, Geldrop, the Netherlands., Brouwer C; Department of Nuclear Medicine, Catharina Hospital Eindhoven, the Netherlands., van Warmerdam LJC; Department of Internal Medicine, Catharina Hospital Eindhoven, the Netherlands., Gielens MPM; Department of Radiology, Catharina Hospital Eindhoven, the Netherlands., van Bommel RMG; Department of Radiology, Anna Hospital, Geldrop, the Netherlands., van Riet YE; Department of Surgery, Catharina Hospital Eindhoven, the Netherlands., Voogd AC; Department of Epidemiology, Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands., Nieuwenhuijzen GAP; Department of Surgery, Catharina Hospital Eindhoven, the Netherlands.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2024 Sep; Vol. 50 (9), pp. 108472. Date of Electronic Publication: 2024 Jun 05.
DOI: 10.1016/j.ejso.2024.108472
Abstrakt: Background: The aim of the present study was to report the 5-year axillary recurrence-free interval (aRFI) in clinically node-positive breast cancer patients treated according to a de-escalating axillary treatment protocol after neoadjuvant systemic therapy (NST).
Methods: All patients diagnosed in two hospitals between October 2014 and March 2021 were identified retrospectively. Data on diagnostic workup, treatment and follow-up was collected. Adjuvant axillary treatment was considered based on the initial staging using 18F-FDG PET/CT and the results of axillary lymph node marking with a radioactive-iodine seed protocol or a targeted axillary dissection procedure. Follow-up was updated until 27th April 2024. Kaplan-Meier curves were calculated to report the 5-year aRFI with corresponding 95 % confident intervals (95%-CI).
Results: A total of 199 patients were included. Axillary pathological complete response was reported in 66 (33.2 %). Based on the treatment protocol and initial clinical staging, no adjuvant axillary treatment was indicated in 30 patients (15 %), while 139 (70 %) received axillary radiotherapy without performance of an axillary lymph node dissection (ALND). The remaining 30 patients (15 %) underwent an ALND with additional locoregional radiotherapy. A median follow-up of 62 months (30-106) showed that 4 (2 %) patients experienced an axillary recurrence after 7, 8, 36 and 36 months, respectively. In all 4 patients, synchronous distant metastases were diagnosed. The estimated 5-year aRFI was 97.8 % (95%-CI 95.6-99.9 %) CONCLUSION: Although longer follow-up should be awaited before final conclusions can be drawn regarding the oncological safety of this approach, the implementation of a de-escalating axillary treatment protocol appears to be safe since the estimated 5-year aRFI is 97.8 %.
Competing Interests: Declaration of competing interest The authors declare to have no conflicts of interest or financial ties to disclose.
(Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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