Management of the axilla in patients with breast cancer and positive sentinel lymph node biopsy: An evidence-based update in a European breast center

Publication date: Available online 13 August 2019Source: European Journal of Surgical OncologyAuthor(s): Carlos A. Garcia-Etienne, Alberta Ferrari, Angelica Della Valle, Marco Lucioni, Elisa Ferraris, Giuseppe Di Giulio, Luigi Squillace, Elisabetta Bonzano, Angioletta Lasagna, Gianpiero Rizzo, Richard Tancredi, Andrea Scotti Foglieni, Francesca Dionigi, Maurizia Grasso, Eloisa Arbustini, Giorgio Cavenaghi, Paolo Pedrazzoli, Andrea R. Filippi, Paolo Dionigi, Adele SgarellaAbstractThe surgical approach to the axilla in breast cancer has been a controversial issue for more than three decades. Data from recently published trials have provided practice-changing recommendations in this scenario. However, further controversies have been triggered in the surgical community, resulting in heterogeneous diffusion of these recommendations.The development of clinical guidelines for the management of the axilla in patients with breast cancer is a work in progress. A multidisciplinary team discussion was held at the research hospital Policlinico San Matteo from the Università degli Studi di Pavia with the aim to update recommendations for the management of the axilla in patients with breast cancer. An evidence-based approach is presented.Our multidisciplinary panel determined that axillary dissection after a positive sentinel lymph node biopsy may be avoided in cN0 patients with micro/macrometastasis to ≤2 sentinel nodes, with age ≥40y, lesions ≤3 cm, who have not received...
Source: European Journal of Surgical Oncology (EJSO) - Category: Surgery Source Type: research

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ConclusionWith the increasing number of elderly primigravida amongst the urban population, a clear understanding of PABC is becoming more important. A multidisciplinary team approach shall help the clinician not only in reducing the heavy burden of patient responsibility but more importantly, in guaranteeing better quality of treatment, avoiding unnecessary delays in providing interventions and providing adequate treatment.
Source: The Journal of Obstetrics and Gynecology of India - Category: OBGYN Source Type: research
This study explores these efforts to preserve the patient ’s breast contour.Patients and MethodsAll patients who underwent surgery for invasive breast cancer in The Netherlands between January 2011 and December 2015 were selected from the Dutch national breast cancer audit (n = 61,309). The breast-contour-preserving procedures (BCPP) rate was defined as the rate of primary BCS, BCS after NAC, or mastectomy with IBR. BCPP rates were calculated and compared by year of diagnosis, age categories, and individual hospitals.ResultsThe rate of primary BCS remained stable (53%) while the BCPP rate increased from...
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
Conclusions: This study is the first to demonstrate a dose-response relationship between risk of complications and near Dmax, where hypofractionated regimen or boost RT can play an important role. Rigorous RT-quality assurance program and modification of dose constraints could be considered as a critically important component for ongoing trials of hypofractionation. Based on our findings, we initiated a multi-center retrospective study (KROG 18-04) and a prospective study (NCT03523078) to validate our findings. Introduction Breast reconstruction provides important psychosocial, cosmetic, and quality of life benefits ...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
Authors: Nurudeen S, Hunt KK Abstract The care of patients with breast cancer in the modern era involves a multimodal approach to treating locoregional and distant disease. Recent studies have demonstrated that the extent of surgical intervention in both the breast and axilla can be minimized through a personalized approach based on breast cancer stage, subtype, and planned adjuvant therapies. The older approach focused on complete removal of the axillary contents for appropriate staging and to determine the need for adjuvant systemic therapy and radiation. This approach has been replaced by sentinel lymph node bio...
Source: Clinical Advances in Hematology and Oncology - Category: Cancer & Oncology Tags: Clin Adv Hematol Oncol Source Type: research
CONCLUSIONS: We reported satisfying long-term outcomes of 487 cases treated by LTDF. LTDF is a suitable oncoplastic technique for BCS. PMID: 30847663 [PubMed - as supplied by publisher]
Source: Breast Cancer - Category: Cancer & Oncology Authors: Tags: Breast Cancer Source Type: research
CONCLUSIONSFor patients with Luminal/HER2 negative breast cancer, the combination of the imaging features of the tumor and the mammary gland, obtained with 18F-FDG PET-CT at baseline and after the first cycle of NAC, may allow the physician to evaluate the probability of BCS.
Source: European Journal of Radiology - Category: Radiology Source Type: research
Publication date: Available online 29 December 2018Source: European Journal of Surgical OncologyAuthor(s): E. Heeg, K. Schreuder, P.E.R. Spronk, J.C. Oosterwijk, P.J. Marang-van de Mheen, S. Siesling, M.T.F.D. Vrancken Peeters, NABON Breast Cancer AuditAbstractPurposePatients may transfer of hospital for clinical reasons but this may delay time to treatment. The purpose of this study is to provide insight in the extent of hospital transfer in breast cancer care; which type of patients transfer and what is the impact on time to treatment.MethodsWe included 41,413 breast cancer patients registered in the Netherlands Cancer R...
Source: European Journal of Surgical Oncology (EJSO) - Category: Surgery Source Type: research
CONCLUSION: BCS after NACT is feasible and safe in terms of LRR, DFS and OS, if patients are properly studied and selected. Indication to BCS after NACT needs of a multidisciplinary assessment considering clinical staging, biological characteristics, the radiological response pattern and the expected concordance between imaging and histology. KEY WORDS: Breast Cancer, Breast-conserving surgery, Neoadjuvant chemotherapy. PMID: 30569900 [PubMed - in process]
Source: Annali Italiani di Chirurgia - Category: Surgery Tags: Ann Ital Chir Source Type: research
ConclusionsAfter NAC, most patients received irradiation of the breast/chest wall and axillary and supraclavicular nodes. In this setting, PORT to breast/chest wall with or without regional nodal irradiation was safe and effective, with acceptable disease-free and overall survival rates reported in this high-risk population.
Source: Reports of Practical Oncology and Radiotherapy - Category: Cancer & Oncology Source Type: research
Conclusions: This study is consistent with previous research showing that breast-conserving surgery after neoadjuvant chemotherapy does not reduce breast cancer–specific survival. In fact, patients undergoing breast-conservation after neoadjuvant therapy appeared to have better survival than patients undergoing mastectomy without radiation.
Source: American Journal of Clinical Oncology - Category: Cancer & Oncology Tags: Original Articles: Breast Source Type: research
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