Uncertainties and controversies in axillary management of patients with breast cancer

Walter P. Weber; Oreste Davide Gentilini; Monica Morrow; Giacomo Montagna; Jana de Boniface; Florian Fitzal; Lynda Wyld; Isabel T. Rubio; Zoltan Matrai; Tari A. King; Ramon Saccilotto; Viviana Galimberti; Nadia Maggi; Mariacarla Andreozzi; Virgilio Sacchini; Liliana Castrezana Lopez; Julie Loesch; Fabienne D. Schwab; Ruth Eller; Martin Heidinger; Martin Haug; Christian Kurzeder; Rosa Di Micco; Maggie Banys-Paluchowski; Nina Ditsch; Yves Harder; Regis R. Paulinelli; Cicero Urban; John Benson; Vesna Bjelic-Radisic; Shelley Potter; Michael Knauer; Marc Thill; Marie-Jeanne Vrancken Peeters; Sherko Kuemmel; Joerg Heil; Bahadir M. Gulluoglu; Christoph Tausch; Ursula Ganz-Blaettler; Jane Shaw; Peter Dubsky; Philip Poortmans; Orit Kaidar-Person; Thorsten Kuehn; Michael Gnant

doi:10.1016/j.ctrv.2023.102556

Uncertainties and controversies in axillary management of patients with breast cancer

Walter P. Weber^*, Oreste Davide Gentilini, Monica Morrow, Giacomo Montagna, Jana de Boniface, Florian Fitzal, Lynda Wyld, Isabel T. Rubio, Zoltan Matrai, Tari A. King, Ramon Saccilotto, Viviana Galimberti, Nadia Maggi, Mariacarla Andreozzi, Virgilio Sacchini, Liliana Castrezana Lopez, Julie Loesch, Fabienne D. Schwab, Ruth Eller, Martin HeidingerMartin Haug, Christian Kurzeder, Rosa Di Micco, Maggie Banys-Paluchowski, Nina Ditsch, Yves Harder, Regis R. Paulinelli, Cicero Urban, John Benson, Vesna Bjelic-Radisic, Shelley Potter, Michael Knauer, Marc Thill, Marie-Jeanne Vrancken Peeters, Sherko Kuemmel, Joerg Heil, Bahadir M. Gulluoglu, Christoph Tausch, Ursula Ganz-Blaettler, Jane Shaw, Peter Dubsky, Philip Poortmans, Orit Kaidar-Person, Thorsten Kuehn, Michael Gnant

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-review

Abstract

The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prior-itized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Sub-sequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, fol-lowed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a pro-spective register.

Original language	English
Article number	102556
Number of pages	12
Journal	Cancer Treatment Reviews
Volume	117
Issue number	1
Early online date	1 Apr 2023
DOIs	https://doi.org/10.1016/j.ctrv.2023.102556
Publication status	Published - 1 Jun 2023

Keywords

Breast cancer
Breast surgery
Axillary dissection
Radiotherapy
LYMPH-NODE DISSECTION
SOUND SENTINEL NODE
NEOADJUVANT CHEMOTHERAPY
INTERNAL MAMMARY
SURGERY
BIOPSY
TRIAL
RADIOTHERAPY
IRRADIATION
MULTICENTER

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Weber, W. P., Gentilini, O. D., Morrow, M., Montagna, G., de Boniface, J., Fitzal, F., Wyld, L., Rubio, I. T., Matrai, Z., King, T. A., Saccilotto, R., Galimberti, V., Maggi, N., Andreozzi, M., Sacchini, V., Lopez, L. C., Loesch, J., Schwab, F. D., Eller, R., ... Gnant, M. (2023). Uncertainties and controversies in axillary management of patients with breast cancer. Cancer Treatment Reviews, 117(1), Article 102556. https://doi.org/10.1016/j.ctrv.2023.102556

@article{1c36569c69c342ba80c1f4fe00ace5e7,

title = "Uncertainties and controversies in axillary management of patients with breast cancer",

abstract = "The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prior-itized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Sub-sequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, fol-lowed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a pro-spective register.",

keywords = "Breast cancer, Breast surgery, Axillary dissection, Radiotherapy, LYMPH-NODE DISSECTION, SOUND SENTINEL NODE, NEOADJUVANT CHEMOTHERAPY, INTERNAL MAMMARY, SURGERY, BIOPSY, TRIAL, RADIOTHERAPY, IRRADIATION, MULTICENTER",

author = "Weber, {Walter P.} and Gentilini, {Oreste Davide} and Monica Morrow and Giacomo Montagna and {de Boniface}, Jana and Florian Fitzal and Lynda Wyld and Rubio, {Isabel T.} and Zoltan Matrai and King, {Tari A.} and Ramon Saccilotto and Viviana Galimberti and Nadia Maggi and Mariacarla Andreozzi and Virgilio Sacchini and Lopez, {Liliana Castrezana} and Julie Loesch and Schwab, {Fabienne D.} and Ruth Eller and Martin Heidinger and Martin Haug and Christian Kurzeder and {Di Micco}, Rosa and Maggie Banys-Paluchowski and Nina Ditsch and Yves Harder and Paulinelli, {Regis R.} and Cicero Urban and John Benson and Vesna Bjelic-Radisic and Shelley Potter and Michael Knauer and Marc Thill and Peeters, {Marie-Jeanne Vrancken} and Sherko Kuemmel and Joerg Heil and Gulluoglu, {Bahadir M.} and Christoph Tausch and Ursula Ganz-Blaettler and Jane Shaw and Peter Dubsky and Philip Poortmans and Orit Kaidar-Person and Thorsten Kuehn and Michael Gnant",

year = "2023",

month = jun,

day = "1",

doi = "10.1016/j.ctrv.2023.102556",

language = "English",

volume = "117",

journal = "Cancer Treatment Reviews",

issn = "0305-7372",

publisher = "ELSEVIER SCI LTD",

number = "1",

}

Weber, WP, Gentilini, OD, Morrow, M, Montagna, G, de Boniface, J, Fitzal, F, Wyld, L, Rubio, IT, Matrai, Z, King, TA, Saccilotto, R, Galimberti, V, Maggi, N, Andreozzi, M, Sacchini, V, Lopez, LC, Loesch, J, Schwab, FD, Eller, R, Heidinger, M, Haug, M, Kurzeder, C, Di Micco, R, Banys-Paluchowski, M, Ditsch, N, Harder, Y, Paulinelli, RR, Urban, C, Benson, J, Bjelic-Radisic, V, Potter, S, Knauer, M, Thill, M, Peeters, M-JV, Kuemmel, S, Heil, J, Gulluoglu, BM, Tausch, C, Ganz-Blaettler, U, Shaw, J, Dubsky, P, Poortmans, P, Kaidar-Person, O, Kuehn, T & Gnant, M 2023, 'Uncertainties and controversies in axillary management of patients with breast cancer', Cancer Treatment Reviews, vol. 117, no. 1, 102556. https://doi.org/10.1016/j.ctrv.2023.102556

TY - JOUR

T1 - Uncertainties and controversies in axillary management of patients with breast cancer

AU - Weber, Walter P.

AU - Gentilini, Oreste Davide

AU - Morrow, Monica

AU - Montagna, Giacomo

AU - de Boniface, Jana

AU - Fitzal, Florian

AU - Wyld, Lynda

AU - Rubio, Isabel T.

AU - Matrai, Zoltan

AU - King, Tari A.

AU - Saccilotto, Ramon

AU - Galimberti, Viviana

AU - Maggi, Nadia

AU - Andreozzi, Mariacarla

AU - Sacchini, Virgilio

AU - Lopez, Liliana Castrezana

AU - Loesch, Julie

AU - Schwab, Fabienne D.

AU - Eller, Ruth

AU - Heidinger, Martin

AU - Haug, Martin

AU - Kurzeder, Christian

AU - Di Micco, Rosa

AU - Banys-Paluchowski, Maggie

AU - Ditsch, Nina

AU - Harder, Yves

AU - Paulinelli, Regis R.

AU - Urban, Cicero

AU - Benson, John

AU - Bjelic-Radisic, Vesna

AU - Potter, Shelley

AU - Knauer, Michael

AU - Thill, Marc

AU - Peeters, Marie-Jeanne Vrancken

AU - Kuemmel, Sherko

AU - Heil, Joerg

AU - Gulluoglu, Bahadir M.

AU - Tausch, Christoph

AU - Ganz-Blaettler, Ursula

AU - Shaw, Jane

AU - Dubsky, Peter

AU - Poortmans, Philip

AU - Kaidar-Person, Orit

AU - Kuehn, Thorsten

AU - Gnant, Michael

PY - 2023/6/1

Y1 - 2023/6/1

N2 - The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prior-itized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Sub-sequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, fol-lowed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a pro-spective register.

AB - The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prior-itized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Sub-sequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, fol-lowed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a pro-spective register.

KW - Breast cancer

KW - Breast surgery

KW - Axillary dissection

KW - Radiotherapy

KW - LYMPH-NODE DISSECTION

KW - SOUND SENTINEL NODE

KW - NEOADJUVANT CHEMOTHERAPY

KW - INTERNAL MAMMARY

KW - SURGERY

KW - BIOPSY

KW - TRIAL

KW - RADIOTHERAPY

KW - IRRADIATION

KW - MULTICENTER

U2 - 10.1016/j.ctrv.2023.102556

DO - 10.1016/j.ctrv.2023.102556

M3 - (Systematic) Review article

C2 - 37126938

SN - 0305-7372

VL - 117

JO - Cancer Treatment Reviews

JF - Cancer Treatment Reviews

IS - 1

M1 - 102556

ER -

Uncertainties and controversies in axillary management of patients with breast cancer

Abstract

Keywords

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