Local Treatment of the Axilla in Early Breast Cancer: So Many Questions, Still Few Answers

Meattini, Icro; Santis, Maria Carmen De; Rose, F. De; Desideri, Isacco; Franco, P.; Kaidar‐Person, Orit; Meduri, Bruno; Pasinetti, Nadia; Lancellotta, Valentina

doi:10.1016/j.clon.2019.08.001

Cited by 10 publications

(5 citation statements)

References 7 publications

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“…More recently, it is increasingly being applied in earlier stage BC, although no advantage in survival was observed as compared to postoperative systemic therapy [ [1] , [2] , [3] , [4] ]. Several studies showed a survival benefit in patients with pathological complete response (pCR), except for luminal A-patients [ 5 , 6 ] suggesting that the response to PST may have clinical implications such as a higher chance to offer breast conserving therapy [ 7 , 8 ] and a less extensive treatment of the axilla, if after PST, tumor-positive (axillary) lymph nodes are converted into ypN0 [ 7 , [9] , [10] , [11] , [12] ]. It means that it is possible to modulate postoperative treatments according to the response to PST, for specific biological types.…”

Section: Introductionmentioning

confidence: 99%

Loco-regional adjuvant radiation therapy in breast cancer patients with positive axillary lymph-nodes at diagnosis (CN2) undergoing preoperative chemotherapy and with complete pathological lymph-nodes response. Development of GRADE (Grades of recommendation, assessment, Development and Evaluation) recommendation by the Italian Association of radiation therapy and Clinical Oncology (AIRO)

et al. 2021

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Section: Introductionmentioning

confidence: 99%

Loco-regional adjuvant radiation therapy in breast cancer patients with positive axillary lymph-nodes at diagnosis (CN2) undergoing preoperative chemotherapy and with complete pathological lymph-nodes response. Development of GRADE (Grades of recommendation, assessment, Development and Evaluation) recommendation by the Italian Association of radiation therapy and Clinical Oncology (AIRO)

et al. 2021

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“…A joint effort of all actors involved in the multidisciplinary board is needed to identify the BC patients for whom it is possible to omit an axillary treatment safely. Additionally, it is essential to define what risk factors we have to consider for the intensification of surgical and adjuvant therapies [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Axillary Management in Breast Cancer Patients Undergoing Upfront Surgery: Results from a Nationwide Survey on Behalf of the Clinical Oncology Breast Cancer Group (COBCG) and the Breast Cancer Study Group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO)

et al. 2023

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Background: We assessed the current practice concerning the axillary management of breast cancer (BC) patients undergoing upfront surgery among radiation oncologists (ROs) practising in Italy. Methods: An online survey via SurveyMonkey (including 21 questions) was distributed amongst ROs in Italy through personal contacts and the Italian Association for Radiotherapy and Clinical Oncology (AIRO) network from August to September 2022. We particularly focused on the emerging omission of axillary lymph node dissection (ALND) in the presence of 1–2 sentinel node-positive patients and the consequent change in the role of regional nodal irradiation (RNI). Results: A total of 101/195 (51% response rate) Italian Radiotherapy Cancer Care Centres answered the survey. With respect to patients with 1–2 sentinel node-positive, the relative proportion of respondents that offer patients ALND a) always, b) only in selected cases, and c) never was 37.6%, 60.4%, and 2.0%, respectively, with no significant geographical (North vs. Centre–South Italy; p = 0.92) or institutional (Academic vs. non-Academic; p = 0.49) differences. Radiation therapy indications varied widely in patients who did not undergo ALND. Among these, about a third of the respondents (17/56, 30.4%) stated that RNI was constantly performed. On the other hand, half of the respondents offered RNI in selected cases, stating that an unfavourable biologic tumour profile and extracapsular nodal extension were considered drivers of their decision. Conclusions: Results of the present survey show the variability of axillary management offered in clinical practice for BC patients undergoing conserving surgery upfront in Italy. Analysis of these attitudes may trigger the modification of some clinical approaches through multidisciplinary collaboration and create the background for future clinical investigations.

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“…Flaps from the back can also be utilized includes the latissimus dorsi (LD) flap. Flaps can also be taken from the gluteal region including the gluteal musculocutaneous and/or perforator flaps (SGAP and IGAP) and upper thigh with the transverse gracilis (TUG) flaps [ 34 , 35 ].…”

Section: Role Of Surgery and The Surgeonmentioning

confidence: 99%

Breast Radiotherapy after Oncoplastic Surgery—A Multidisciplinary Approach

Metz

Snook

Sood

et al. 2022

Cancers

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Oncoplastic breast surgery encompasses a range of techniques used to provide equitable oncological outcomes compared with standard breast surgery while, simultaneously, prioritizing aesthetic outcomes. While the outcomes of oncoplastic breast surgery are promising, it can add an extra complexity to the treatment paradigm of breast cancer and impact on decision-making surrounding adjuvant therapies, like chemotherapy and radiotherapy. As such, early discussions at the multidisciplinary team meeting with surgeons, medical oncologists, and radiation oncologists present, should be encouraged to facilitate best patient care.

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Local Treatment of the Axilla in Early Breast Cancer: So Many Questions, Still Few Answers

Cited by 10 publications

References 7 publications

Axillary Management in Breast Cancer Patients Undergoing Upfront Surgery: Results from a Nationwide Survey on Behalf of the Clinical Oncology Breast Cancer Group (COBCG) and the Breast Cancer Study Group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO)

Breast Radiotherapy after Oncoplastic Surgery—A Multidisciplinary Approach

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