Uncertainties and controversies in axillary management of patients with breast cancer
Walter P Weber 1 , Oreste Davide Gentilini 2 , Monica Morrow 3 , Giacomo Montagna 3 , Jana de Boniface 4 , Florian Fitzal 5 , Lynda Wyld 6 , Isabel T Rubio 7 , Zoltan Matrai 8 , Tari A King 9 , Ramon Saccilotto 10 , Viviana Galimberti 11 , Nadia Maggi 12 , Mariacarla Andreozzi 12 , Virgilio Sacchini 3 , Liliana Castrezana López 13 , Julie Loesch 14 , Fabienne D Schwab 12 , Ruth Eller 12 , Martin Heidinger 12 , Martin Haug 12 , Christian Kurzeder 12 , Rosa Di Micco 2 , Maggie Banys-Paluchowski 15 , Nina Ditsch 16 , Yves Harder 17 , Régis R Paulinelli 18 , Cicero Urban 19 , John Benson 20 , Vesna Bjelic-Radisic 21 , Shelley Potter 22 , Michael Knauer 23 , Marc Thill 24 , Marie-Jeanne Vrancken Peeters 25 , Sherko Kuemmel 26 , Joerg Heil 27 , Bahadir M Gulluoglu 28 , Christoph Tausch 29 , Ursula Ganz-Blaettler 30 , Jane Shaw 31 , Peter Dubsky 32 , Philip Poortmans 33 , Orit Kaidar-Person 34 , Thorsten Kühn 35 , Michael Gnant 36
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 prioritized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries.
Subsequently, 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, followed 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 prospective register.
CITATION Cancer Treat Rev. 2023 Apr 23;117:102556. doi: 10.1016/j.ctrv.2023.102556