Axillary management after neoadjuvant treatment: Minerva Chirurgica

G. Montagna; G. Corso; R. Di Micco; N. van Den Rul; N. Rocco

doi:10.23736/S0026-4733.20.08600-9

Axillary management after neoadjuvant treatment: Minerva Chirurgica

G. Montagna, G. Corso, R. Di Micco, N. van Den Rul, N. Rocco

Research output: Contribution to journal › Article › peer-review

Abstract

Since its introduction nearly 30 years ago, sentinel lymph node biopsy (SLNB) has become the standard technique to stage the axilla for the great majority of patients with early breast cancer. While the accuracy of SLNB in clinically nodenegative patients who undergo neoadjuvant chemotherapy (NAC) is similar to the upfront surgery setting, modifications of the technique to improve the false negative rate are necessary in node-positive patients at presentation. Currently, patients who present with matted nodes, cN1 patients who fail to downstage to cN0 with NAC and those with pathological residual disease have an indication to undergo axillary lymph node dissection. Ongoing trials will confirm if extensive nodal irradiation can replace surgery in patients with residual nodal disease after NAC and if nodal radiotherapy can be omitted in patients who achieve nodal pathological complete response. The aim of this review was to focus on the open questions on the management of the axilla after NAC. © 2020 Edizioni Minerva Medica. All rights reserved.

Original language	English
Pages (from-to)	400-407
Number of pages	8
Journal	Minerva Chir.
Volume	75
Issue number	6
DOIs	https://doi.org/10.23736/S0026-4733.20.08600-9
Publication status	Published - 2020

Keywords

Adjuvant
Axilla
Breast neoplasms
Chemotherapy
Sentinel lymph node biopsy

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10.23736/S0026-4733.20.08600-9

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@article{b048362f427949afbc9c0021bc81fb15,

title = "Axillary management after neoadjuvant treatment: Minerva Chirurgica",

abstract = "Since its introduction nearly 30 years ago, sentinel lymph node biopsy (SLNB) has become the standard technique to stage the axilla for the great majority of patients with early breast cancer. While the accuracy of SLNB in clinically nodenegative patients who undergo neoadjuvant chemotherapy (NAC) is similar to the upfront surgery setting, modifications of the technique to improve the false negative rate are necessary in node-positive patients at presentation. Currently, patients who present with matted nodes, cN1 patients who fail to downstage to cN0 with NAC and those with pathological residual disease have an indication to undergo axillary lymph node dissection. Ongoing trials will confirm if extensive nodal irradiation can replace surgery in patients with residual nodal disease after NAC and if nodal radiotherapy can be omitted in patients who achieve nodal pathological complete response. The aim of this review was to focus on the open questions on the management of the axilla after NAC. {\textcopyright} 2020 Edizioni Minerva Medica. All rights reserved.",

keywords = "Adjuvant, Axilla, Breast neoplasms, Chemotherapy, Sentinel lymph node biopsy",

author = "G. Montagna and G. Corso and {Di Micco}, R. and {van Den Rul}, N. and N. Rocco",

note = "Export Date: 17 March 2021 CODEN: MICHA Correspondence Address: Montagna, G.; Breast Unit, United States; email: montagng@mskcc.org References: King, TA, Morrow, M., Surgical issues in patients with breast cancer receiving neoadjuvant chemotherapy (2015) Nat Rev Clin Oncol, 12, pp. 335-343; Gralow, JR, Burstein, HJ, Wood, W, Hortobagyi, GN, Gianni, L, von Minckwitz, G, Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease (2008) J Clin Oncol, 26, pp. 814-819; Burstein, HJ, Curigliano, G, Loibl, S, Dubsky, P, Gnant, M, Poortmans, P, Estimating the benefits of therapy for early-stage breast cancer: the St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019 (2019) Ann Oncol, 30, pp. 1541-1557. , Members of the St. Gallen International Consensus Panel on the Primary Therapy of Early Breast Cancer 2019; Fisher, B, Bryant, J, Wolmark, N, Mamounas, E, Brown, A, Fisher, ER, Effect of preoperative chemotherapy on the outcome of women with operable breast cancer (1998) J Clin Oncol, 16, pp. 2672-2685; Mieog, JS, van der Hage, JA, van de Velde, CJ., Neoadjuvant chemotherapy for operable breast cancer (2007) Br J Surg, 94, pp. 1189-1200; Petruolo, O, Sevilimedu, V, Montagna, G, Le, T, Morrow, M, Barrio, AV., How Often Does Modern Neoadjuvant Chemotherapy Downstage Patients to Breast-Conserving Surgery? (2020) Ann Surg Oncol, , [Epub ahead of print]; Boughey, JC, McCall, LM, Ballman, KV, Mittendorf, EA, Ahrendt, GM, Wilke, LG, Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial (2014) Ann Surg, 260, pp. 608-614. , 14, discussion 6; Montagna, G, Mamtani, A, Knezevic, A, Brogi, E, Barrio, AV, Morrow, M., Selecting Node-Positive Patients for Axillary Downstaging with Neoadjuvant Chemotherapy (2020) Ann Surg Oncol, 27, pp. 4515-4522; Schmid, P, Cortes, J, Pusztai, L, McArthur, H, K{\"u}mmel, S, Bergh, J, Pembrolizumab for Early Triple-Negative Breast Cancer (2020) N Engl J Med, 382, pp. 810-821. , KEYNOTE-522 Investigators; Litton, JK, Scoggins, ME, Hess, KR, Adrada, BE, Murthy, RK, Damodaran, S, Neoadjuvant Talazoparib for Patients With Operable Breast Cancer With a Germline BRCA Pathogenic Variant (2020) J Clin Oncol, 38, pp. 388-394; Riedel, F, Hoffmann, AS, Moderow, M, Heublein, S, Deutsch, TM, Golatta, M, Time trends of neoadjuvant chemotherapy for early breast cancer (2020) Int J Cancer, 147, pp. 3049-3058; Simons, JM, Maaskant-Braat, AJ, Luiten, EJ, Leidenius, MH, van Nijnatten, TJ, Boelens, PG, Patterns of axillary staging and management in clinically node positive breast cancer patients treated with neoadjuvant systemic therapy: re-sults of a survey amongst breast cancer specialists (2020) Eur J Surg Oncol, 46, pp. 53-58; Caudle, AS, Bedrosian, I, Milton, DR, DeSnyder, SM, Kuerer, HM, Hunt, KK, Use of Sentinel Lymph Node Dissection After Neoadjuvant Chemotherapy in Patients with Node-Positive Breast Cancer at Diagnosis: Practice Patterns of American Society of Breast Surgeons Members (2017) Ann Surg Oncol, 24, pp. 2925-2934; Caudle, AS, Yang, WT, Krishnamurthy, S, Mittendorf, EA, Black, DM, Gilcrease, MZ, Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection (2016) J Clin Oncol, 34, pp. 1072-1078; Henke, G, Knauer, M, Ribi, K, Hayoz, S, G{\'e}rard, MA, Ruhstaller, T, Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): study protocol for a multicenter, randomized phase-III trial (2018) Trials, 19, p. 667; Donker, M, Straver, ME, Wesseling, J, Loo, CE, Schot, M, Drukker, CA, Marking axillary lymph nodes with radioactive iodine seeds for axillary staging after neoadjuvant systemic treatment in breast cancer patients: the MARI procedure (2015) Ann Surg, 261, pp. 378-382; Galimberti, V, Ribeiro Fontana, SK, Maisonneuve, P, Steccanella, F, Vento, AR, Intra, M, Sentinel node biopsy after neoadjuvant treatment in breast cancer: fiveyear follow-up of patients with clinically node-negative or node-positive disease before treatment (2016) Eur J Surg Oncol, 42, pp. 361-368; (2020) Standard or Comprehensive Radiation Therapy in Treating Patients With Early-Stage Breast Cancer Previously Treated With Chemotherapy and Surgery, , https://clinicaltrials.gov/ct2/show/NCT01872975, Clinicaltrials. 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year = "2020",

doi = "10.23736/S0026-4733.20.08600-9",

language = "English",

volume = "75",

pages = "400--407",

journal = "Minerva Chir.",

issn = "0026-4733",

publisher = "Edizioni Minerva Medica S.p.A.",

number = "6",

}

TY - JOUR

T1 - Axillary management after neoadjuvant treatment

T2 - Minerva Chirurgica

AU - Montagna, G.

AU - Corso, G.

AU - Di Micco, R.

AU - van Den Rul, N.

AU - Rocco, N.

N1 - Export Date: 17 March 2021 CODEN: MICHA Correspondence Address: Montagna, G.; Breast Unit, United States; email: montagng@mskcc.org References: King, TA, Morrow, M., Surgical issues in patients with breast cancer receiving neoadjuvant chemotherapy (2015) Nat Rev Clin Oncol, 12, pp. 335-343; Gralow, JR, Burstein, HJ, Wood, W, Hortobagyi, GN, Gianni, L, von Minckwitz, G, Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease (2008) J Clin Oncol, 26, pp. 814-819; Burstein, HJ, Curigliano, G, Loibl, S, Dubsky, P, Gnant, M, Poortmans, P, Estimating the benefits of therapy for early-stage breast cancer: the St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019 (2019) Ann Oncol, 30, pp. 1541-1557. , Members of the St. Gallen International Consensus Panel on the Primary Therapy of Early Breast Cancer 2019; Fisher, B, Bryant, J, Wolmark, N, Mamounas, E, Brown, A, Fisher, ER, Effect of preoperative chemotherapy on the outcome of women with operable breast cancer (1998) J Clin Oncol, 16, pp. 2672-2685; Mieog, JS, van der Hage, JA, van de Velde, CJ., Neoadjuvant chemotherapy for operable breast cancer (2007) Br J Surg, 94, pp. 1189-1200; Petruolo, O, Sevilimedu, V, Montagna, G, Le, T, Morrow, M, Barrio, AV., How Often Does Modern Neoadjuvant Chemotherapy Downstage Patients to Breast-Conserving Surgery? (2020) Ann Surg Oncol, , [Epub ahead of print]; Boughey, JC, McCall, LM, Ballman, KV, Mittendorf, EA, Ahrendt, GM, Wilke, LG, Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial (2014) Ann Surg, 260, pp. 608-614. , 14, discussion 6; Montagna, G, Mamtani, A, Knezevic, A, Brogi, E, Barrio, AV, Morrow, M., Selecting Node-Positive Patients for Axillary Downstaging with Neoadjuvant Chemotherapy (2020) Ann Surg Oncol, 27, pp. 4515-4522; Schmid, P, Cortes, J, Pusztai, L, McArthur, H, Kümmel, S, Bergh, J, Pembrolizumab for Early Triple-Negative Breast Cancer (2020) N Engl J Med, 382, pp. 810-821. , KEYNOTE-522 Investigators; Litton, JK, Scoggins, ME, Hess, KR, Adrada, BE, Murthy, RK, Damodaran, S, Neoadjuvant Talazoparib for Patients With Operable Breast Cancer With a Germline BRCA Pathogenic Variant (2020) J Clin Oncol, 38, pp. 388-394; Riedel, F, Hoffmann, AS, Moderow, M, Heublein, S, Deutsch, TM, Golatta, M, Time trends of neoadjuvant chemotherapy for early breast cancer (2020) Int J Cancer, 147, pp. 3049-3058; Simons, JM, Maaskant-Braat, AJ, Luiten, EJ, Leidenius, MH, van Nijnatten, TJ, Boelens, PG, Patterns of axillary staging and management in clinically node positive breast cancer patients treated with neoadjuvant systemic therapy: re-sults of a survey amongst breast cancer specialists (2020) Eur J Surg Oncol, 46, pp. 53-58; Caudle, AS, Bedrosian, I, Milton, DR, DeSnyder, SM, Kuerer, HM, Hunt, KK, Use of Sentinel Lymph Node Dissection After Neoadjuvant Chemotherapy in Patients with Node-Positive Breast Cancer at Diagnosis: Practice Patterns of American Society of Breast Surgeons Members (2017) Ann Surg Oncol, 24, pp. 2925-2934; Caudle, AS, Yang, WT, Krishnamurthy, S, Mittendorf, EA, Black, DM, Gilcrease, MZ, Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection (2016) J Clin Oncol, 34, pp. 1072-1078; Henke, G, Knauer, M, Ribi, K, Hayoz, S, Gérard, MA, Ruhstaller, T, Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): study protocol for a multicenter, randomized phase-III trial (2018) Trials, 19, p. 667; Donker, M, Straver, ME, Wesseling, J, Loo, CE, Schot, M, Drukker, CA, Marking axillary lymph nodes with radioactive iodine seeds for axillary staging after neoadjuvant systemic treatment in breast cancer patients: the MARI procedure (2015) Ann Surg, 261, pp. 378-382; Galimberti, V, Ribeiro Fontana, SK, Maisonneuve, P, Steccanella, F, Vento, AR, Intra, M, Sentinel node biopsy after neoadjuvant treatment in breast cancer: fiveyear follow-up of patients with clinically node-negative or node-positive disease before treatment (2016) Eur J Surg Oncol, 42, pp. 361-368; (2020) Standard or Comprehensive Radiation Therapy in Treating Patients With Early-Stage Breast Cancer Previously Treated With Chemotherapy and Surgery, , https://clinicaltrials.gov/ct2/show/NCT01872975, Clinicaltrials. [Internet]. [cited 2020, Oct 27]; (2020) Comparison of Axillary Lymph Node Dissection With Axillary Radiation for Patients With Node-Positive Breast Cancer Treated With Chemotherapy, , https://clinicaltrials.gov/ct2/show/record/NCT01901094, Clinicaltrials. [Internet]. 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PY - 2020

Y1 - 2020

N2 - Since its introduction nearly 30 years ago, sentinel lymph node biopsy (SLNB) has become the standard technique to stage the axilla for the great majority of patients with early breast cancer. While the accuracy of SLNB in clinically nodenegative patients who undergo neoadjuvant chemotherapy (NAC) is similar to the upfront surgery setting, modifications of the technique to improve the false negative rate are necessary in node-positive patients at presentation. Currently, patients who present with matted nodes, cN1 patients who fail to downstage to cN0 with NAC and those with pathological residual disease have an indication to undergo axillary lymph node dissection. Ongoing trials will confirm if extensive nodal irradiation can replace surgery in patients with residual nodal disease after NAC and if nodal radiotherapy can be omitted in patients who achieve nodal pathological complete response. The aim of this review was to focus on the open questions on the management of the axilla after NAC. © 2020 Edizioni Minerva Medica. All rights reserved.

AB - Since its introduction nearly 30 years ago, sentinel lymph node biopsy (SLNB) has become the standard technique to stage the axilla for the great majority of patients with early breast cancer. While the accuracy of SLNB in clinically nodenegative patients who undergo neoadjuvant chemotherapy (NAC) is similar to the upfront surgery setting, modifications of the technique to improve the false negative rate are necessary in node-positive patients at presentation. Currently, patients who present with matted nodes, cN1 patients who fail to downstage to cN0 with NAC and those with pathological residual disease have an indication to undergo axillary lymph node dissection. Ongoing trials will confirm if extensive nodal irradiation can replace surgery in patients with residual nodal disease after NAC and if nodal radiotherapy can be omitted in patients who achieve nodal pathological complete response. The aim of this review was to focus on the open questions on the management of the axilla after NAC. © 2020 Edizioni Minerva Medica. All rights reserved.

KW - Adjuvant

KW - Axilla

KW - Breast neoplasms

KW - Chemotherapy

KW - Sentinel lymph node biopsy

U2 - 10.23736/S0026-4733.20.08600-9

DO - 10.23736/S0026-4733.20.08600-9

M3 - Article

VL - 75

SP - 400

EP - 407

JO - Minerva Chir.

JF - Minerva Chir.

SN - 0026-4733

IS - 6

ER -