Tailored axillary surgery in patients with clinically node-positive breast cancer: Pre-planned feasibility substudy of TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101)

Breast

Stefanie Seiler¹  Stefanie Hayoz²  Inna Meyer³  Markus Ackerknecht⁴  Giang Thanh Lam⁵  Conny Vrieling⁶  Magdalena Kohlik⁷  Zoltan Matrai⁸  Peter M. Fehr⁸  Guido Henke⁹  Christian F. Singer^1,10  Mattea Reinisch^1,11  Christian Kurzeder^1,12  Ruth Exner^1,13  Loïc Lelièvre^1,14  Günther Gruber^1,15  Tatiana Naydina^1,16  Alexandra Schulz^1,17  Klaus Reisenberger^1,18  Roland Reitsamer^1,19  Gilles Berclaz^2,20  Konstantin J. Dedes^2,21  Dimitri Sarlos^2,21  Hisham Fansa^2,22  Jörg Heil^2,23  Jelena Winkler^2,24  Rahel Nussbaumer^2,25  Cornelia Leo^2,26  Colin Simonson^2,27  Walter P. Weber^2,27  Pagona Markellou^2,28  Susanne Bucher^2,29  Nadia Maggi^3,30  Charles Becciolini^3,30  Michael Knauer^3,31  Natalie Gabriel^3,32  Christoph Tausch^3,32  Florian Fitzal^3,33  Karine Clerc^3,34  Valerijus Ostapenko^3,35  Peter Dubsky^3,36  Christopher Hager^3,37  Charlotte Maddox^3,38  Robert Maráz^3,39  Frank Zimmermann^4,40  Mathias K. Fehr^4,41  Thomas Ruhstaller^4,42  Vesna Bjelic-Radisic^4,43  Daniel R. Zwahlen^4,43  Sherko Kuemmel^4,43  Daniel Egle^4,44  Rok Satler^4,45  Simone Muenst^4,45  Mihály Újhelyi^4,45 

[1] Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland;Corresponding author. Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.;Department of Biomedicine, University Hospital Basel, Basel, Switzerland;Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland;Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland;Spital Zollikerberg, Zurich, Switzerland;University of Basel, Basel, Switzerland;University of Szeged, H-6725 Szeged, Hungary;Breast Cancer Center, University Hospital of Zurich, Zurich, Switzerland;Breast Center Bern, Lindenhof Group, Bern, Switzerland;Breast Center Eastern Switzerland, St. Gallen, Switzerland;Breast Center Graubünden, Cantonal Hospital Graubünden, Chur, Switzerland;Breast Center Thurgau, Münsterlingen, Switzerland;Breast Center Zurich, Zurich, Switzerland;;Breast Center Zürich, Bethanien &Breast Center, Basel Bethesda Hospital, Basel, Switzerland;Breast Center, Cantonal Hospital Aarau, Aarau, Switzerland;Breast Center, Cantonal Hospital Baden, Baden, Switzerland;Breast Center, Cantonal Hospital Lucerne, Lucerne, Switzerland;Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland;Breast Center, City Hospital Triemli, Zurich, Switzerland;Breast Center, Clinique de Genolier, Genolier, Switzerland;Breast Center, Hirslanden Klinik St. Anna, Lucerne, Switzerland;Breast Center, Paracelsus Medical University of Salzburg, Salzburg, Austria;Breast Center, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland;Breast Center, University Hospital Basel, Basel, Switzerland;Breast Center, University Hospital of Geneva, Geneva, Switzerland;Breast Unit, Helios University Clinic, University Witten/Herdecke, Germany;Breast Unit, Kliniken Essen-Mitte, Essen, Germany;Brustzentrum Freiburg, Centre du sein Fribourg, Fribourg, Switzerland;Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary;Department of Gynecology and Obstetrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;Department of Gynecology and Obstetrics, City Hospital, Dornbirn, Austria;Department of Gynecology and Obstetrics, Klinikum Wels-Grieskirchen, Wels, Austria;Department of Gynecology, Centre Hospitalier du Haut-Valais (SZO), Sion, Switzerland;Department of Oncology, Bacs-Kiskun Country Hospital, Kecskemet, Hungary;Department of Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland;Department of Radiation Oncology, Hirslanden Clinique des Grangettes, Geneva, Switzerland;Department of Radiation Oncology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland;Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;Institute of Radiotherapy, Klinik Hirslanden, Zurich, Switzerland;SAKK Coordinating Center, Bern, Switzerland;Spital Limmattal, Schlieren, Switzerland;University of Basel, Basel, Switzerland;

关键词: Breast cancer;    Breast surgery;    Axillary dissection;    Sentinel lymph node procedure;    Axillary staging;   

DOI  :  

来源: DOAJ

【 摘 要 】

Aim: We developed tailored axillary surgery (TAS) to reduce the axillary tumor volume in patients with clinically node-positive breast cancer to the point where radiotherapy can control it. The aim of this study was to quantify the extent of tumor load reduction achieved by TAS. Methods: International multicenter prospective study embedded in a randomized trial. TAS is a novel pragmatic concept for axillary surgery de-escalation that combines palpation-guided removal of suspicious nodes with the sentinel procedure and, optionally, imaging-guided localization. Pre-specified study endpoints quantified surgical extent and reduction of tumor load. Results: A total of 296 patients were included at 28 sites in four European countries, 125 (42.2%) of whom underwent neoadjuvant chemotherapy (NACT) and 71 (24.0%) achieved nodal pathologic complete response. Axillary metastases were detectable only by imaging in 145 (49.0%) patients. They were palpable in 151 (51.0%) patients, of whom 63 underwent NACT and 21 had residual palpable disease after NACT. TAS removed the biopsied and clipped node in 279 (94.3%) patients. In 225 patients with nodal disease at the time of surgery, TAS removed a median of five (IQR 3–7) nodes, two (IQR 1–4) of which were positive. Of these 225 patients, 100 underwent ALND after TAS, which removed a median of 14 (IQR 10–17) additional nodes and revealed additional positive nodes in 70/100 (70%) of patients. False-negative rate of TAS in patients who underwent subsequent ALND was 2.6%. Conclusions: TAS selectively reduced the tumor load in the axilla and remained much less radical than ALND.

【 授权许可】

Unknown