4.6 Review

The Lucerne Toolbox 2 to optimise axillary management for early breast cancer: a multidisciplinary expert consensus

Related references

Note: Only part of the references are listed.
Article Oncology

Radiotherapy or Surgery of the Axilla After a Positive Sentinel Node in Breast Cancer: 10-Year Results of the Randomized Controlled EORTC 10981-22023 AMAROS Trial

Sanne A. L. Bartels et al.

Summary: This clinical trial compared axillary lymph node dissection (ALND) with axillary radiotherapy (ART) in patients with cT1-2, node-negative breast cancer. The study found that both modalities had comparable axillary control, but ART was associated with less morbidity. Additionally, patients in the ART group had a higher risk of developing second primary cancers.

JOURNAL OF CLINICAL ONCOLOGY (2023)

Article Oncology

Abemaciclib plus endocrine therapy for hormone receptor-positive, HER2-negative, node-positive, high-risk early breast cancer (monarchE): results from a preplanned interim analysis of a randomised, open-label, phase 3 trial

Stephen R. D. Johnston et al.

Summary: In patients with high-risk hormone receptor-positive, HER2-negative early breast cancer, adjuvant abemaciclib plus endocrine therapy improves invasive disease-free survival and distant relapse-free survival. The benefit of abemaciclib extends beyond the completion of treatment, supporting its use in this patient population.

LANCET ONCOLOGY (2023)

Article Oncology

Axillary Staging Is Not Justified in Postmenopausal Clinically Node-Negative Women Based on Nodal Disease Burden

Minna K. Lee et al.

Summary: The study found that postmenopausal women with no nodal burden and low recurrence risk do not benefit from adjuvant chemotherapy. Therefore, axillary staging can be omitted in this group of patients with cN0 breast cancer.

ANNALS OF SURGICAL ONCOLOGY (2023)

Article Oncology

Definitive Radiation With Nodal Boost for Patients With Locally Advanced Breast Cancer

Juhi M. Purswani et al.

Summary: This study aimed to evaluate the outcomes of breast cancer patients with advanced nodal disease who received a nodal boost. The majority of failures were distant, and the IMN + ax/SCV group had the highest failure rate, indicating the need for further treatment escalation.

PRACTICAL RADIATION ONCOLOGY (2023)

Article Medicine, General & Internal

Patient-reported outcomes for the Intergroup Sentinel Mamma study (INSEMA): A randomised trial with persistent impact of axillary surgery on arm and breast symptoms in patients with early breast cancer

Toralf Reimer et al.

Summary: The INSEMA trial evaluated the non-inferiority of avoiding sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) in clinically node-negative breast cancer patients. Patient-reported outcomes (PROs) were assessed using the EORTC QLQ-C30 and BR23 questionnaires. The study found that patients with no SLNB had better outcomes in terms of breast and arm symptoms, while there were no relevant differences in other scales.

ECLINICALMEDICINE (2023)

Review Oncology

Uncertainties and controversies in axillary management of patients with breast cancer

Walter P. Weber et al.

Summary: The aim of this study was to address uncertainties and controversies in axillary management of early breast cancer and make appropriate recommendations through a global consensus panel. By using the Delphi method, 15 questions were prioritized by over 250 breast surgeons, patient advocates, and radiation oncologists from 60 countries. The panel agreed on prioritizing research based on current evidence and updating recommendations as ongoing studies provide more data.

CANCER TREATMENT REVIEWS (2023)

Review Oncology

The lymphatic system and sentinel lymph nodes: conduit for cancer metastasis

Stanley P. Leong et al.

Summary: The lymphatic system is a complex system composed of lymphatic vessels and lymph nodes. It functions to drain extracellular fluid containing cellular debris, excess water, and toxins to the circulatory system. Lymph nodes act as filters to ensure the sterility of the lymph fluid returning to the heart. Through this system, cancer cells can enter lymphatic vessels and nodes.

CLINICAL & EXPERIMENTAL METASTASIS (2022)

Article Oncology

Intelligent Vacuum-Assisted Biopsy to Identify Breast Cancer Patients With Pathologic Complete Response (ypT0 and ypN0) After Neoadjuvant Systemic Treatment for Omission of Breast and Axillary Surgery

Andre Pfob et al.

Summary: Neoadjuvant systemic treatment is effective for breast cancer patients, but current nonsurgical methods cannot accurately identify patients without residual cancer. We developed an intelligent vacuum-assisted biopsy approach using machine learning algorithm, which can reliably exclude residual cancer.

JOURNAL OF CLINICAL ONCOLOGY (2022)

Article Oncology

Preservation of Axillary Lymph Nodes Compared with Complete Dissection in T1-2 Breast Cancer Patients Presenting One or Two Metastatic Sentinel Lymph Nodes: The SINODAR-ONE Multicenter Randomized Clinical Trial

Corrado Tinterri et al.

Summary: The SINODAR-ONE trial aimed to assess whether SLN biopsy only would worsen the prognosis compared with ALND in patients with T1-2 breast cancer and one or two macrometastatic SLNs. The results showed that the 3-year survival and relapse rates of patients treated with SLNB only were not inferior to those treated with ALND.

ANNALS OF SURGICAL ONCOLOGY (2022)

Article Oncology

Patient-reported outcomes one year after positive sentinel lymph node biopsy with or without axillary lymph node dissection in the randomized SENOMAC trial

Matilda Appelgren et al.

Summary: This report evaluates the impact of axillary lymph node dissection (ALND) on health related quality of life (HRQoL) and patient-reported arm morbidity one year after breast cancer surgery. The study found that ALND did not have a negative impact on HRQoL and could reduce arm morbidity in patients.

BREAST (2022)

Article Oncology

Three-year follow-up of de-escalated axillary treatment after neoadjuvant systemic therapy in clinically node-positive breast cancer: the MARI-protocol

Ariane A. van Loevezijn et al.

Summary: In cN+ breast cancer patients, response-adjusted axillary treatment according to the MARI-protocol prevented ALND in 80% of patients and resulted in an excellent three-year aRFI of 98%.

BREAST CANCER RESEARCH AND TREATMENT (2022)

Article Oncology

The forgotten node: Axillary surgery mandates expertise

Orit Kaidar-Person et al.

Summary: The therapeutic role of axillary dissection in breast cancer is being abandoned, but it is still necessary in certain cases and requires expertise in surgical planning, axillary marking methods, and more radical resection.
Article Oncology

Biomarkers for Adjuvant Endocrine and Chemotherapy in Early-Stage Breast Cancer: ASCO Guideline Update

Fabrice Andre et al.

Summary: This article provides updated recommendations on the appropriate use of breast cancer biomarker assay results in guiding adjuvant endocrine and chemotherapy decisions for early-stage breast cancer. Based on the latest literature and expert consensus, specific biomarker assay results can be used to guide treatment decisions for patients who meet certain criteria. However, other factors such as disease stage, comorbidities, and patient preferences should also be considered.

JOURNAL OF CLINICAL ONCOLOGY (2022)

Review Pathology

Sentinel lymph node assessment in breast cancer-an update on current recommendations

Gabor Cserni et al.

Summary: This review discusses the background and trends of SLNB, as well as European national recommendations and divergent daily practices in pathology departments. It also highlights the challenges in classifying residual nodal involvement into TNM categories in the post-neoadjuvant setting and summarizes the neoadjuvant therapy-related aspects of SLNB.

VIRCHOWS ARCHIV (2022)

Article Oncology

De-escalation of radiotherapy after primary chemotherapy in cT1-2N1 breast cancer (RAPCHEM; BOOG 2010-03): 5-year follow-up results of a Dutch, prospective, registry study

Sabine R. de Wild et al.

Summary: This study aimed to evaluate the oncological safety of de-escalated locoregional radiotherapy in patients with cT1-2N1 breast cancer treated with primary chemotherapy, according to a predefined, consensus-based study guideline.

LANCET ONCOLOGY (2022)

Article Oncology

The association of internal mammary and medial supraclavicular lymph node radiation technique with clinical outcomes: Results from the EORTC 22922/10925 randomised trial

Orit Kaidar-Person et al.

Summary: This study analyzed the effects of different techniques of IM-MS lymph node irradiation on long-term outcomes in breast cancer patients. The results showed that using more individualized radiation therapy techniques can improve oncological outcomes without increasing the risk of late side effects.

RADIOTHERAPY AND ONCOLOGY (2022)

Article Surgery

A Prospective, Multicenter Registry Study to Evaluate the Clinical Feasibility of Targeted Axillary Dissection (TAD) in Node-positive Breast Cancer Patients

Sherko Kuemmel et al.

Summary: The study demonstrates the feasibility of TAD in a real-world cohort of breast cancer patients, which is of great importance for the de-escalation of surgical strategies.

ANNALS OF SURGERY (2022)

Article Oncology

Continuous positive airway pressure with deep inspiration breath hold in left-sided breast radiation therapy

Jensen Reckhow et al.

Summary: The study evaluated the use of CPAP as an alternative to conventional methods for reducing heart and lung dose in breast cancer radiation therapy. Results showed that CPAP significantly reduced heart and lung doses, making it a potential strategy for patients who cannot perform deep inspiration breath hold (DIBH) or require additional dose reduction.

MEDICAL DOSIMETRY (2021)

Article Oncology

Customizing local and systemic therapies for women with early breast cancer: the St. Gallen International Consensus Guidelines for treatment of early breast cancer 2021

H. J. Burstein et al.

Summary: The 17th St Gallen International Breast Cancer Consensus Conference in 2021 was held virtually, with over 3300 participants discussing key issues related to early breast cancer diagnosis and treatment. The conference emphasized customized recommendations for breast cancer treatment, highlighting the importance of individualized clinical features in patient care.

ANNALS OF ONCOLOGY (2021)

Article Oncology

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)

Walter P. Weber et al.

Summary: Tailored axillary surgery (TAS) is an effective method to reduce tumor load in the axilla of patients with clinically node-positive breast cancer, with a much less radical approach compared to axillary lymph node dissection (ALND).

BREAST (2021)

Review Oncology

Omission of sentinel node biopsy for breast cancer: Historical context and future perspectives on a modern controversy

Ismail Jatoi et al.

Summary: Before abandoning the sentinel node biopsy (SNB) procedure in breast cancer management, additional studies and considerations must be taken into account. Specifically, there is a need for level I evidence to demonstrate that omitting the SNB procedure will improve patient quality of life, and suitable alternatives as a guide for adjuvant radiotherapy decision making need to be validated.

CANCER (2021)

Review Oncology

De-escalation of axillary irradiation for early breast cancer-Has the time come?

El zbieta Senkus et al.

Summary: The introduction of sentinel lymph node biopsy and regional nodal irradiation has significantly improved outcomes for breast cancer patients, while more effective systemic therapies have created the opportunity for de-escalation of locoregional treatments. Current research is exploring the possibility of omitting axillary irradiation in certain patient populations.

CANCER TREATMENT REVIEWS (2021)

Review Oncology

Breast conservation and axillary management after primary systemic therapy in patients with early-stage breast cancer: the Lucerne toolbox

Peter Dubsky et al.

Summary: An international consortium was established to provide clinical guidance and tools for the technical management of patients with early-stage breast cancer through discussions and consensus meetings. During the meeting, 42% of statements reached a consensus, 38% were supported by the majority, and 21% did not reach a decision.

LANCET ONCOLOGY (2021)

Article Medicine, General & Internal

21-Gene Assay to Inform Chemotherapy Benefit in Node-Positive Breast Cancer

Kevin Kalinsky et al.

Summary: The study showed that among premenopausal women with hormone-receptor-positive, HER2-negative breast cancer and one to three positive lymph nodes with a recurrence score of 25 or lower, the addition of chemotherapy to endocrine therapy led to longer invasive disease-free survival and distant relapse-free survival compared to endocrine therapy alone. However, postmenopausal women with similar characteristics did not benefit from adjuvant chemotherapy in terms of invasive disease-free survival.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

Article Oncology

Updated Standardized Definitions for Efficacy End Points (STEEP) in Adjuvant Breast Cancer Clinical Trials: STEEP Version 2.0

Sara M. Tolaney et al.

Summary: This study assessed the adherence of primary efficacy end points in adjuvant breast cancer trials to standardized definitions. Simulation modeling revealed the impact of excluding second nonbreast primary cancers on outcomes, leading to the recommendation of adding invasive breast cancer-free survival as an additional end point.

JOURNAL OF CLINICAL ONCOLOGY (2021)

Article Oncology

Management of the Axilla in Early-Stage Breast Cancer: Ontario Health (Cancer Care Ontario) and ASCO Guideline

Muriel Brackstone et al.

Summary: This study aims to provide recommendations on the management and treatment of the axilla for patients with early-stage breast cancer, based on a systematic review of the literature, including the use of sentinel lymph node biopsy. The recommendations primarily cover axillary staging, treatment strategies, and optimal identification methods for early-stage breast cancer patients.

JOURNAL OF CLINICAL ONCOLOGY (2021)

Article Oncology

Side Effects 15 Years After Lymph Node Irradiation in Breast Cancer: Randomized EORTC Trial 22922/10925

Philip M. Poortmans et al.

Summary: This study investigated long-term late side effects of lymph node irradiation in breast cancer patients and found that IM-MS lymph node irradiation significantly increased the risk of pulmonary and cardiac side effects. However, the overall incidence rates were low and there was no increased risk of non-breast cancer-related mortality.

JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE (2021)

Review Oncology

Tricks and tips for target volume definition and delineation in breast cancer: Lessons learned from ESTRO breast courses

Orit Kaidar-Person et al.

Summary: Delineation of target and 'organ at risk' volumes is crucial in modern radiation therapy planning, especially for treating breast cancer. This paper provides tips and tricks for optimal target volume definition and delineation in postoperative breast cancer irradiation.

RADIOTHERAPY AND ONCOLOGY (2021)

Article Oncology

Knowledge gaps in oncoplastic breast surgery

Walter P Weber et al.

LANCET ONCOLOGY (2020)

Article Radiology, Nuclear Medicine & Medical Imaging

Biopsy Marker Standardization: What's in a Name?

Leah H. Portnowt et al.

AMERICAN JOURNAL OF ROENTGENOLOGY (2019)

Article Medicine, General & Internal

Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer

G. von Minckwitz et al.

NEW ENGLAND JOURNAL OF MEDICINE (2019)

Article Medicine, General & Internal

Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy

N. Masuda et al.

NEW ENGLAND JOURNAL OF MEDICINE (2017)

Letter Oncology

Sized Influences Nodal Status in Women Aged #70 with Endocrine Responsive Breast Cancer

Florian Fitzal et al.

ANNALS OF SURGICAL ONCOLOGY (2017)

Article Medicine, General & Internal

Adjuvant Paclitaxel and Trastuzumab for Node-Negative, HER2-Positive Breast Cancer

Sara M. Tolaney et al.

NEW ENGLAND JOURNAL OF MEDICINE (2015)

Article Medicine, General & Internal

Regional Nodal Irradiation in Early-Stage Breast Cancer

Timothy J. Whelan et al.

NEW ENGLAND JOURNAL OF MEDICINE (2015)

Article Medicine, General & Internal

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

P. M. Poortmans et al.

NEW ENGLAND JOURNAL OF MEDICINE (2015)

Article Medicine, General & Internal

Sentinel Lymph Node Surgery After Neoadjuvant Chemotherapy in Patients With Node-Positive Breast Cancer The ACOSOG Z1071 (Alliance) Clinical Trial

Judy C. Boughey et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2013)

Editorial Material Medicine, General & Internal

Surgical Margins in Lumpectomy for Breast Cancer - Bigger Is Not Better

Monica Morrow et al.

NEW ENGLAND JOURNAL OF MEDICINE (2012)

Article Medicine, General & Internal

Effect of Occult Metastases on Survival in Node-Negative Breast Cancer

Donald L. Weaver et al.

NEW ENGLAND JOURNAL OF MEDICINE (2011)

Editorial Material Oncology

The Breast Cancer Alternative Hypothesis: Is There Evidence to Justify Replacing It?

Bernard Fisher et al.

JOURNAL OF CLINICAL ONCOLOGY (2010)