Local Treatment of the Axilla in Early Breast Cancer: Concepts from the National Surgical Adjuvant Breast and Bowel Project B-04 to the Planned Intergroup Sentinel Mamma Trial

Reimer, Toralf; Hartmann, Steffi; Stachs, Angrit; Gerber, Bernd

doi:10.1159/000360411

Cited by 71 publications

(54 citation statements)

References 74 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Currently ongoing trials such as SOUND and INSEMA, 6,7 because they are conducted on the entire population of early breast cancers, may lack a sufficient number of events and consequently will demonstrate the noninferiority in avoiding ALND. By considering the other emerging factors 42,43 that influence survival after ALND in breast carcinoma, such studies should investigate specific subgroups, not the entire population of patients.…”

Section: Resultsmentioning

confidence: 99%

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Marrazzo

Damiano

Taörmina³

et al. 2017

Clinical Breast Cancer

View full text Add to dashboard Cite

We performed a retrospective analysis of 1156 patients affected by early breast cancer in order to estimate the real incidence of patients with T1 tumors presenting > 2 metastatic lymph nodes. The advantage of axillary surgery seems to be limited only to a specific subgroup of T1 patients who are undergoing conservative surgery plus radiotherapy. Background: The role of axillary surgery for early breast carcinoma treated with conservative surgery and radiotherapy is currently the subject of considerable investigation. Recent studies have supported the noninferiority of avoiding axillary surgery in terms of overall survival when sentinel lymph node biopsy (SLNB) presents 2 positive lymph nodes, thus sparing the patients from complications. There are some ongoing studies investigating the possibility of omitting SLNB. Axillary study seems to be sufficiently replaced by SLNB for staging the disease. Axillary surgery maintains a therapeutic role in the presence of > 2 metastatic lymph nodes at SLNB. Patients and Methods: We performed a retrospective analysis of 1156 patients with early breast cancer to estimate the real incidence of patients with T1 tumors presenting > 2 metastatic lymph nodes. Results: Of the 1156 cases, only 106 (9.2%) had > 2 axillary metastatic lymph nodes. More specifically, 38 (4.3%) of 884 T1 cases, and 6 (2.3%) of 257 of T1b cases had > 2 metastatic lymph nodes. Conclusion: The advantage of axillary surgery seems to be limited only to a specific subgroup of T1 patients who are undergoing conservative surgery plus radiotherapy. The ongoing studies on avoiding SLNB will likely prove the noninferiority of omitting biopsy because these studies are conducted in the whole population of early breast cancers. It is necessary to identify more accurately the subpopulation of patients who may benefit from axillary surgery.

show abstract

Section: Resultsmentioning

confidence: 99%

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Marrazzo

Damiano

Taörmina³

et al. 2017

Clinical Breast Cancer

View full text Add to dashboard Cite

show abstract

“…At present, axillary lymphadenectomy is increasingly more rarely performed due to the introduction into clinical practice, within conserving therapy, of the method of determination of the sentinel lymph node [11][12][13][14]. In the group of patients analysed, the treatment was conducted in accordance with valid Polish recommendations.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of combined treatment of patients with early breast cancer after conserving therapy

Kędzierawski¹,

Ciepiela²,

Florek³

et al. 2016

View full text Add to dashboard Cite

Introduction: Mastectomy was the most frequently used method of surgical treatment of patients with breast cancer in the Kielce Region. With the opening of the Surgical Oncology Clinic and the Department of Radiotherapy in the Holycross Cancer Centre, a larger number of patients could undergo breast-conserving therapy. Aim of the research: The objective of the study was evaluation of the remote outcome of treatment of patients with breast cancer after conserving therapy. Material and methods: During the period 2001-2005, in the Holycross Cancer Centre, 65 women with early-stage breast cancer underwent breast-conserving therapy. The patients were subjected to combined treatment. The total period of observation was from 105 to 143 months; median 113 months. In statistical analysis the distribution of the investigated variables was examined using the Kolmogorov-Smirnov test and Lillefors test. The significance of the differences between the variables analysed was tested by means of the Mann-Whitney U test. The probability of survival without symptoms of the disease was estimated by the Kaplan-Meier method. The cosmetic outcome was evaluated based on individual medical observations and a questionnaire developed at the Department of Radiotherapy. Results and conclusions: Relapse of the disease was noted in 5 (8%) patients. Local recurrence occurred in 2 (3%) patients. In the analysed group, the 2-, 3-, 5-, and 10-year survival rates without symptoms were 98.5%, 96.9%, 95.4%, and 95.4%, respectively. No statistically significant differences were found between the groups of patients with and without cancer. In the majority of patients, after many-year observation, the cosmetic outcome is good.

show abstract

“…It is expected that the INSEMA study that is currently in progress will clarify the diagnostic and therapeutic procedure in patients with cN0. Two additional prospective studies (NCT 02 466 737 and NCT 02 167 490) are also investigating whether it might even be possible to dispense with SNB when the axilla is negative on ultrasound [31,32].…”

Section: The Clinically Negative Axillamentioning

confidence: 99%

Radiotherapy of the lymphatic drainage pathways in breast carcinoma: time for a reassessment

Piroth

Sautter-Bihl

Baumann

et al. 2017

Senologie - Zeitschrift für Mammadiagnostik und -therapie

View full text Add to dashboard Cite

Background The treatment administered for regional lymph nodes has altered dramatically in recent years. The state of the evidence on radiotherapy has also substantially improved and a reassessment is required. Materials and results Randomized studies are available on axillary surgery versus radiotherapy (AMAROS); on refraining from axillary dissection after a positive sentinel node (SN) when radiotherapy is planned (ACOSOG Z0011); and on adjuvant radiotherapy of the regional lymph nodes (LNs). ACOSOG Z0011 shows that refraining from axillary dissection is possible even when there are one or two positive SNs. The meta-analysis of the studies on adjuvant radiotherapy for the regional LNs (EORTC, Canadian, and French studies) shows a significant survival benefit with radiotherapy, and a Danish cohort study has confirmed this result. The reduction in breast cancer–specific mortality in these studies was partly based on a “systemic” effect of regional radiotherapy, with a reduction in the rate of distant metastases. Conclusions The principle applying in surgical treatment of the axilla is “less is not worse.” By contrast, the principle applying in radiotherapy of the regional lymph nodes is “more may be better in some circumstances.” There is as yet no clear explanation for the discrepancy between these two findings. An immunological effect (through immunogenic cell death due to irradiation) has been discussed. Further research is needed on which patients are today capable of benefiting from regional radiotherapy.

show abstract

Local Treatment of the Axilla in Early Breast Cancer: Concepts from the National Surgical Adjuvant Breast and Bowel Project B-04 to the Planned Intergroup Sentinel Mamma Trial

Cited by 71 publications

References 74 publications

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Long-term results of combined treatment of patients with early breast cancer after conserving therapy

Radiotherapy of the lymphatic drainage pathways in breast carcinoma: time for a reassessment

Contact Info

Product

Resources

About