Journal
BREAST CARE
Volume 7, Issue 1, Pages 61-66Publisher
KARGER
DOI: 10.1159/000336983
Keywords
Breast cancer: local therapy, surgery, radiotherapy; Expert panel
Categories
Funding
- Austrian Society of Senology
- Austrian Society of Surgical Oncology
- Austrian Society of surgery
- Austrian society of gynecology and obstetrics
- Austrian society of radiation oncology
- Austrian society of radiology
- Austrian society of plastic, esthetic and reconstructive surgery
- Austrian society of pathology
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At the first Austrian multidisciplinary expert panel on controversies in local treatment of breast cancer, 22 experts of all relevant disciplines discussed current areas of debate (surgery of the breast, surgery and pathology of the axilla, reconstructive surgery, radiotherapy, and imaging) in local therapy. The most controversial area of debate was the area of axillary surgery. The panel agreed that it was no longer necessary to perform completion axillary lymph node dissection (ALND) when micrometastases are diagnosed in the sentinel lymph node. The only prospective trial comparing patients with sentinel node macrometastases with or without completion ALND had to be terminated early due to failure in sufficient patient recruitment. As long as the frequently discussed issues have not been solved and in light of the lack of any clear level 1 evidence, the panel decided not to recommend omitting axillary dissection in patients with 1 or 2 macrometastases meeting the inclusion criteria of the ACOSOG Z0011 trial. The Austrian panel similarly decided not to recommend omitting axillary dissection in patients with macrometastases and low-risk breast cancer in general. These decisions reflect the increasing skepticism of the scientific community against rapidly shifting paradigms without sufficient and clear evidence.
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