TY  - JOUR
A1  - Banys-Paluchowski, Maggie
A1  - Gasparri, Maria Luisa
A1  - de Boniface, Jana
A1  - Gentilini, Oreste
A1  - Stickeler, Elmar
A1  - Hartmann, Steffi
A1  - Thill, Marc
A1  - Rubio, Isabel T.
A1  - Di Micco, Rosa
A1  - Bonci, Eduard-Alexandru
A1  - Niinikoski, Laura
A1  - Kontos, Michalis
A1  - Cakmak, Guldeniz Karadeniz
A1  - Hauptmann, Michael
A1  - Peintinger, Florentia
A1  - Pinto, David
A1  - Matrai, Zoltan
A1  - Murawa, Dawid
A1  - Kadayaprath, Geeta
A1  - Dostalek, Lukas
A1  - Nina, Helidon
A1  - Krivorotko, Petr
A1  - Classe, Jean-Marc
A1  - Schlichting, Ellen
A1  - Appelgren, Matilda
A1  - Paluchowski, Peter
A1  - Solbach, Christine
A1  - Blohmer, Jens-Uwe
A1  - Kühn, Thorsten
T1  - Surgical management of the axilla in clinically node-positive breast cancer patients converting to clinical node negativity through neoadjuvant chemotherapy: current status, knowledge gaps, and rationale for the EUBREAST-03 AXSANA study
T2  - Cancers
N2  - Simple Summary: Currently, it is unclear which kind of axillary staging surgery breast cancer patients with lymph node metastasis should receive after neoadjuvant chemotherapy. For decades, these patients have been treated with a full axillary lymph node dissection, even if they converted to clinical node negativity. However, the removal of a large number of lymph nodes during the procedure can increase arm morbidity and impact quality of life. Therefore, several studies investigated less radical surgical strategies in this setting, such as sentinel lymph node biopsy or targeted axillary dissection, i.e., removal of a previously marked node combined with sentinel node removal. In this review, we summarize current evidence on the different surgical techniques and compare national and international recommendations. We show that many questions regarding oncological safety of different surgery types and the optimal marking technique remain unanswered and present the multinational prospective cohort study AXSANA that will address these open issues.
Abstract: In the last two decades, surgical methods for axillary staging in breast cancer patients have become less extensive, and full axillary lymph node dissection (ALND) is confined to selected patients. In initially node-positive patients undergoing neoadjuvant chemotherapy, however, the optimal management remains unclear. Current guidelines vary widely, endorsing different strategies. We performed a literature review on axillary staging strategies and their place in international recommendations. This overview defines knowledge gaps associated with specific procedures, summarizes currently ongoing clinical trials that address these unsolved issues, and provides the rationale for further research. While some guidelines have already implemented surgical de-escalation, replacing ALND with, e.g., sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) in cN+ patients converting to clinical node negativity, others recommend ALND. Numerous techniques are in use for tagging lymph node metastasis, but many questions regarding the marking technique, i.e., the optimal time for marker placement and the number of marked nodes, remain unanswered. The optimal number of SLNs to be excised also remains a matter of debate. Data on oncological safety and quality of life following different staging procedures are lacking. These results provide the rationale for the multinational prospective cohort study AXSANA initiated by EUBREAST, which started enrollment in June 2020 and aims at recruiting 3000 patients in 20 countries (NCT04373655; Funded by AGO-B, Claudia von Schilling Foundation for Breast Cancer Research, AWOgyn, EndoMag, Mammotome, and MeritMedical).
KW  - neoadjuvant therapy
KW  - breast cancer
KW  - therapy response
KW  - targeted axillary dissection
KW  - marked lymph node
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/62136
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-621368
SN  - 2072-6694
N1  - The funding of the AXSANA study has been described in detail in the manuscript.
VL  - 13
IS  - 7, art. 1565
SP  - 1
EP  - 25
PB  - MDPI
CY  - Basel
ER  -