Tailored axillary treatment after neoadjuvant systemic therapy in clinically node-positive breast cancer patients is safe: 3-year follow-up of the MARI protocol

Loevezijn, A. Van; Noordaa, M.E.M. van der; Duijnhoven, Frederieke van; Groen, Emma J.; Stokkel, Marcel P. M.; Loo, Claudette E.; Elkhuizen, P.; Russell, N.S.; Vrancken-Peeters, M.J.

doi:10.1016/s0959-8049(20)30538-4

Cited by 4 publications

(4 citation statements)

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“…Interestingly, ALND is being omitted in both patients with axillary-pCR, and those with residual disease [28,29]. However, it is unclear whether omitting ALND or replacing ALND by radiotherapy in cN+ patients treated with NST is safe with regard to long-term prognosis [31].…”

Section: Discussionmentioning

confidence: 99%

“…While the less invasive axillary staging procedures are being implemented in daily practice, ALND is more frequently replaced by axillary radiotherapy [28][29][30]. However, there is only little evidence that it is safe to omit standard ALND in cN+ patients undergoing NST, in terms of survival and recurrence rates [31]. Furthermore, it is unknown how this trend affects quality of life (QoL), the importance of which has grown as the survival and recurrence rates of breast cancer improve.…”

Section: Introductionmentioning

confidence: 99%

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MINImal vs. MAXimal Invasive Axillary Staging and Treatment After Neoadjuvant Systemic Therapy in Node Positive Breast Cancer: Protocol of a Dutch Multicenter Registry Study (MINIMAX)

Wild

Simons

Peeters

et al. 2022

Clinical Breast Cancer

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

MINImal vs. MAXimal Invasive Axillary Staging and Treatment After Neoadjuvant Systemic Therapy in Node Positive Breast Cancer: Protocol of a Dutch Multicenter Registry Study (MINIMAX)

Wild

Simons

Peeters

et al. 2022

Clinical Breast Cancer

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“…In the present study, observers did not agree on upstaging with prone position FDG-PET/CT in any of the patients. Furthermore, an equally high three-year axillary RFS of 98% was recently reported in all patients who underwent the MARI-protocol at the Netherlands Cancer Institute, which included more than one-third of patients who were staged using FDG-PET/CT in supine position only [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

[18F]FDG-PET/CT in prone compared to supine position for optimal axillary staging and treatment in clinically node-positive breast cancer patients with neoadjuvant systemic therapy

et al. 2021

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Purpose Axillary staging before neoadjuvant systemic therapy in clinically node-positive breast cancer patients with tailored axillary treatment according to the Marking Axillary lymph nodes with radioactive iodine seeds (MARI)-protocol, a protocol developed at the Netherlands Cancer Institute, is performed with [18F] fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT). We aimed to assess the value of FDG-PET/CT in prone compared to standard supine position for axillary staging. Methods We selected patients with FDG-PET/CT in supine and prone position who underwent the MARI-protocol. One hour after administration of 3.5 MBq/kg, [18F]FDG-PET was performed with a low-dose prone position CT-thorax followed by a supine whole-body scan. Scans were separately reviewed by two nuclear medicine physicians and categorized by number of FDG-positive axillary lymph nodes (ALNs; cALN<4 or cALN≥4). Main outcome was axillary up- or downstaging. Results Of 153 patients included, 24 (16%) patients were up- or downstaged at evaluation of prone images: One observer upstaged 14 patients, downstaged 3 patients and reported a higher number of ALNs (3.6 vs. 3.2, p < 0.001), while staging (4 up- and 5 downstaged) and number of ALNs (2.8 vs. 2.8) did not differ for the other. Observers agreed on up- or downstaging in only 1 (1%) patient. Irrespective of supine or prone position scanning, observers agreed on axillary staging in 124 (81%) patients and disagreed in 5 (3%). Interobserver agreement was lower with prone assessments (86%, K = 0.67) than supine (92%, K = 0.80). Conclusions Axillary staging with FDG-PET/CT in prone compared to supine position did not result in concordant up- or downstaging. Therefore, FDG-PET/CT in supine position only can be considered sufficient for axillary staging.

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“…The NSABP-B51/RTOG 1304 and ATNEC trials include patients with axillary-pCR (NCT01872975, NCT04109079), the Alliance A011202 and TAXIS trials include patients with residual disease (NCT01901094, NCT03513614), and the MINIMAX registry study includes both patients with an axillary-pCR and those with residual disease (NCT04486495). Furthermore, the 3-year follow-up results of response-guided axillary treatment according to the MARI protocol [50] (i.e., use of PET-CT as pre-NST staging, followed by the MARI procedure as post-NST staging) in a cohort of 272 patients were presented at EBCC 2020 [51].…”

Section: Response-guided Axillary Treatment and Long-term Prognosismentioning

confidence: 99%

De-Escalating Axillary Surgery in Node-Positive Breast Cancer Treated with Neoadjuvant Systemic Therapy

et al. 2021

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Background: There is a trend towards de-escalating axillary staging and treatment in breast cancer patients. On account of neoadjuvant systemic therapy, node-positive breast cancer patients can achieve a pathological complete response of the axilla. It is hypothesized that these patients do not benefit from an axillary lymph node dissection (ALND), and thus may be spared the risk of severe post-surgical morbidity. In an effort to omit standard ALND, less invasive axillary staging procedures are being implemented to establish response-guided treatment. However, it is unclear which less invasive staging procedure is most accurate, and long-term data are missing with regard to their oncologic safety. Summary: This article provides an overview of the literature on currently used less invasive axillary staging procedures, the accuracy and feasibility of these procedures in clinical practice, important issues concerning axillary treatment, and issues to be addressed in ongoing or future studies. Key messages: More evidence is needed regarding the safety of replacing standard ALND by less invasive axillary staging procedures in terms of long-term prognosis. These less invasive staging procedures not only serve to select patients who may benefit from treatment de-escalation, but also to select patients who may benefit from treatment escalation.

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Tailored axillary treatment after neoadjuvant systemic therapy in clinically node-positive breast cancer patients is safe: 3-year follow-up of the MARI protocol

Cited by 4 publications

References 0 publications

MINImal vs. MAXimal Invasive Axillary Staging and Treatment After Neoadjuvant Systemic Therapy in Node Positive Breast Cancer: Protocol of a Dutch Multicenter Registry Study (MINIMAX)

MINImal vs. MAXimal Invasive Axillary Staging and Treatment After Neoadjuvant Systemic Therapy in Node Positive Breast Cancer: Protocol of a Dutch Multicenter Registry Study (MINIMAX)

[18F]FDG-PET/CT in prone compared to supine position for optimal axillary staging and treatment in clinically node-positive breast cancer patients with neoadjuvant systemic therapy

De-Escalating Axillary Surgery in Node-Positive Breast Cancer Treated with Neoadjuvant Systemic Therapy

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