Erschienen in:
26.11.2018 | ASO Author Reflections
ASO Author Reflections: Reducing Axillary Lymph Node Dissections in Node-Positive Breast Cancer Patients
verfasst von:
Marieke E. M. van der Noordaa, MD, Marie-Jeanne T. F. D. Vrancken Peeters, MD, PhD
Erschienen in:
Annals of Surgical Oncology
|
Sonderheft 3/2018
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Excerpt
Improvements in neoadjuvant systemic therapy (NST) for breast cancer patients have led to increasing rates of pathologic complete response (pCR), allowing for less-extensive surgery of the breast and axillary lymph nodes (ALNs). Despite current pCR rates as high as 80% in patients with HER2+/hormone receptor-negative tumors,
1 ALN dissections (ALNDs) are still frequently performed in clinically node positive (cN+) patients, leading to unnecessary comorbidity. One of the challenges that interferes with the potential to de-escalate axillary management is the continuing lack of consensus on the optimal axillary staging method in cN+ patients post-NST. Whereas post-NST sentinel lymph node biopsy (SLNB) can be safely performed in cN0 patients, SLNB is associated with high false-negative rates (FNRs) in cN+ patients.
2 In addition, trials analyzing axillary staging after NST mainly focus on cN1 patients, while pCR rates in cN2–3 patients are also high. Omitting ALND in these patients could greatly reduce comorbidity since radiotherapy is indicated regardless of response in these patients. …
