Arbeitsgemeinschaft Gynäkologische Onkologie Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2023

Abstract

Background: Each year the interdisciplinary AGO (Arbeitsgemeinschaft Gynäkologische Onkologie, German Gynecological Oncology Group) Breast Committee on Diagnosis and Treatment of Breast Cancer provides updated state-of-the-art recommendations for early and metastatic breast cancer. Summary: The updated evidence-based treatment recommendation for early and metastatic breast cancer have been released in March 2023. Key messages: This paper concisely captures the updated recommendations for early breast cancer chapter by chapter.

Radiotherapy statements of the 18th St. Gallen International Breast Cancer Consensus Conference—a German expert perspective

“…In patients who have endocrine therapy, these numbers decreased to 62 and 40%, respectively. In the German guidelines [ 3 , 6 ], individual discussion of adjuvant radiotherapy with consideration of the individual risk profile is recommended. Endocrine therapy is not universally recommended in the German guidelines.…”

“…In addition to the numerous randomized controlled trials for invasive breast cancer, the BIG 3–07/TROG 07.01 trial showed similar outcomes among 503 patients randomized to conventional fractionation vs. moderate hypofractionation [ 8 ]. The AGO guideline includes moderate hypofractionation for DCIS with the same grade of recommendation as conventional fractionation (LoE 1a, GR A, AGO +) [ 6 ]. Although there is less evidence regarding moderate hypofractionation for DCIS than for invasive breast cancer, German experts agree that reduced acute toxicity, increased patient convenience, and decreased costs favor the use of moderate hypofractionation.…”

“…While moderate hypofractionation is indisputably the standard of care for whole-breast radiotherapy, there is less evidence for RNI and DCIS. Due to emerging data from randomized controlled trials presented at international conferences demonstrating noninferiority of moderate hypofractionation for RNI, the AGO has upgraded moderate hypofractionation (LoE 1b GR A AGO +) [ 6 ]. Although the ESTRO-ACROP consensus guideline [ 15 ] states that ultrahypofractionation can be offered as a standard of care or in the context of trials or registries (86.9% consensus), the voting results mentioned above suggest that this is not universally accepted.…”

“…Although the ESTRO-ACROP consensus guideline [ 15 ] states that ultrahypofractionation can be offered as a standard of care or in the context of trials or registries (86.9% consensus), the voting results mentioned above suggest that this is not universally accepted. This is also reflected in the AGO (LoE 1b GR B AGO +/−) and DEGRO guidelines [ 6 , 16 ]. Nevertheless, German experts agree that ultrahypofractionation is a valid option after BCS or mastectomy without reconstruction if there is no indication for RNI, especially for elderly and frail breast cancer patients who are not considered good candidates for radiotherapy omission.…”

“…The voting results were discussed in two hybrid meetings among the authors of this manuscript on March 18th and 19th, 2023. Results from the 18th St. Gallen International Breast Cancer Consensus Conference are discussed in light of the German S3 guideline [ 3 ] and the 2023 version of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) guidelines [ 4 , 5 ]. For statements from the AGO guidelines, the Oxford level of evidence (LoE), Oxford grade of recommendation (GR), and AGO grade of recommendation (AGO; ++ = highly beneficial for patients, should be performed; + = limited benefit, can be performed; +/− = may be performed only in individual cases, a general recommendation cannot be given; − = can be of disadvantage for patients and might not be performed; −− = clear disadvantage for patients and should be avoided or omitted in any case) are stated.…”