Uncertainties and controversies in axillary management of patients with breast cancer

Walter P Weber; Oreste Davide Gentilini; Monica Morrow; Giacomo Montagna; Jana de Boniface; Florian Fitzal; Lynda Wyld; Isabel T Rubio; Zoltan Matrai; Tari A King; Ramon Saccilotto; Viviana Galimberti; Nadia Maggi; Mariacarla Andreozzi; Virgilio Sacchini; Liliana Castrezana López; Julie Loesch; Fabienne D Schwab; Ruth Eller; Martin Heidinger; Martin Haug; Christian Kurzeder; Rosa Di Micco; Maggie Banys-Paluchowski; Nina Ditsch; Yves Harder; Régis R Paulinelli; Cicero Urban; John Benson; Vesna Bjelic-Radisic; Shelley Potter; Michael Knauer; Marc Thill; Marie-Jeanne Vrancken Peeters; Sherko Kuemmel; Joerg Heil; Bahadir M Gulluoglu; Christoph Tausch; Ursula Ganz-Blaettler; Jane Shaw; Peter Dubsky; Philip Poortmans; Orit Kaidar-Person; Thorsten Kühn; Michael Gnant

doi:10.1016/j.ctrv.2023.102556

Uncertainties and controversies in axillary management of patients with breast cancer

Walter P Weber^*, Oreste Davide Gentilini, Monica Morrow, Giacomo Montagna, Jana de Boniface, Florian Fitzal, Lynda Wyld, Isabel T Rubio, Zoltan Matrai, Tari A King, Ramon Saccilotto, Viviana Galimberti, Nadia Maggi, Mariacarla Andreozzi, Virgilio Sacchini, Liliana Castrezana López, Julie Loesch, Fabienne D Schwab, Ruth Eller, Martin HeidingerMartin Haug, Christian Kurzeder, Rosa Di Micco, Maggie Banys-Paluchowski, Nina Ditsch, Yves Harder, Régis R Paulinelli, Cicero Urban, John Benson, Vesna Bjelic-Radisic, Shelley Potter, Michael Knauer, Marc Thill, Marie-Jeanne Vrancken Peeters, Sherko Kuemmel, Joerg Heil, Bahadir M Gulluoglu, Christoph Tausch, Ursula Ganz-Blaettler, Jane Shaw, Peter Dubsky, Philip Poortmans, Orit Kaidar-Person, Thorsten Kühn, Michael Gnant

^*Corresponding author for this work

Research output: Contribution to journal › Review article (Academic Journal) › peer-review

12 Citations (Scopus)

Abstract

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.

Original language	English
Article number	102556
Number of pages	12
Journal	Cancer Treatment Reviews
Volume	117
Early online date	22 Apr 2023
DOIs	https://doi.org/10.1016/j.ctrv.2023.102556
Publication status	Published - 1 Jun 2023

Bibliographical note

Keywords

Humans
Female
Breast Neoplasms/surgery
Lymph Node Excision/methods
Lymphatic Metastasis
Sentinel Lymph Node Biopsy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Weber, W. P., Davide Gentilini, O., Morrow, M., Montagna, G., de Boniface, J., Fitzal, F., Wyld, L., Rubio, I. T., Matrai, Z., King, T. A., Saccilotto, R., Galimberti, V., Maggi, N., Andreozzi, M., Sacchini, V., Castrezana López, L., Loesch, J., Schwab, F. D., Eller, R., ... Gnant, M. (2023). Uncertainties and controversies in axillary management of patients with breast cancer. Cancer Treatment Reviews, 117, Article 102556. https://doi.org/10.1016/j.ctrv.2023.102556

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title = "Uncertainties and controversies in axillary management of patients with breast cancer",

abstract = "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.",

keywords = "Humans, Female, Breast Neoplasms/surgery, Lymph Node Excision/methods, Lymphatic Metastasis, Sentinel Lymph Node Biopsy",

author = "Weber, {Walter P} and {Davide Gentilini}, Oreste and Monica Morrow and Giacomo Montagna and {de Boniface}, Jana and Florian Fitzal and Lynda Wyld and Rubio, {Isabel T} and Zoltan Matrai and King, {Tari A} and Ramon Saccilotto and Viviana Galimberti and Nadia Maggi and Mariacarla Andreozzi and Virgilio Sacchini and {Castrezana L{\'o}pez}, Liliana and Julie Loesch and Schwab, {Fabienne D} and Ruth Eller and Martin Heidinger and Martin Haug and Christian Kurzeder and {Di Micco}, Rosa and Maggie Banys-Paluchowski and Nina Ditsch and Yves Harder and Paulinelli, {R{\'e}gis R} and Cicero Urban and John Benson and Vesna Bjelic-Radisic and Shelley Potter and Michael Knauer and Marc Thill and {Vrancken Peeters}, Marie-Jeanne and Sherko Kuemmel and Joerg Heil and Gulluoglu, {Bahadir M} and Christoph Tausch and Ursula Ganz-Blaettler and Jane Shaw and Peter Dubsky and Philip Poortmans and Orit Kaidar-Person and Thorsten K{\"u}hn and Michael Gnant",

year = "2023",

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doi = "10.1016/j.ctrv.2023.102556",

language = "English",

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Weber, WP, Davide Gentilini, O, Morrow, M, Montagna, G, de Boniface, J, Fitzal, F, Wyld, L, Rubio, IT, Matrai, Z, King, TA, Saccilotto, R, Galimberti, V, Maggi, N, Andreozzi, M, Sacchini, V, Castrezana López, L, Loesch, J, Schwab, FD, Eller, R, Heidinger, M, Haug, M, Kurzeder, C, Di Micco, R, Banys-Paluchowski, M, Ditsch, N, Harder, Y, Paulinelli, RR, Urban, C, Benson, J, Bjelic-Radisic, V, Potter, S, Knauer, M, Thill, M, Vrancken Peeters, M-J, Kuemmel, S, Heil, J, Gulluoglu, BM, Tausch, C, Ganz-Blaettler, U, Shaw, J, Dubsky, P, Poortmans, P, Kaidar-Person, O, Kühn, T & Gnant, M 2023, 'Uncertainties and controversies in axillary management of patients with breast cancer', Cancer Treatment Reviews, vol. 117, 102556. https://doi.org/10.1016/j.ctrv.2023.102556

TY - JOUR

T1 - Uncertainties and controversies in axillary management of patients with breast cancer

AU - Weber, Walter P

AU - Davide Gentilini, Oreste

AU - Morrow, Monica

AU - Montagna, Giacomo

AU - de Boniface, Jana

AU - Fitzal, Florian

AU - Wyld, Lynda

AU - Rubio, Isabel T

AU - Matrai, Zoltan

AU - King, Tari A

AU - Saccilotto, Ramon

AU - Galimberti, Viviana

AU - Maggi, Nadia

AU - Andreozzi, Mariacarla

AU - Sacchini, Virgilio

AU - Castrezana López, Liliana

AU - Loesch, Julie

AU - Schwab, Fabienne D

AU - Eller, Ruth

AU - Heidinger, Martin

AU - Haug, Martin

AU - Kurzeder, Christian

AU - Di Micco, Rosa

AU - Banys-Paluchowski, Maggie

AU - Ditsch, Nina

AU - Harder, Yves

AU - Paulinelli, Régis R

AU - Urban, Cicero

AU - Benson, John

AU - Bjelic-Radisic, Vesna

AU - Potter, Shelley

AU - Knauer, Michael

AU - Thill, Marc

AU - Vrancken Peeters, Marie-Jeanne

AU - Kuemmel, Sherko

AU - Heil, Joerg

AU - Gulluoglu, Bahadir M

AU - Tausch, Christoph

AU - Ganz-Blaettler, Ursula

AU - Shaw, Jane

AU - Dubsky, Peter

AU - Poortmans, Philip

AU - Kaidar-Person, Orit

AU - Kühn, Thorsten

AU - Gnant, Michael

PY - 2023/6/1

Y1 - 2023/6/1

N2 - 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.

AB - 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.

KW - Humans

KW - Female

KW - Breast Neoplasms/surgery

KW - Lymph Node Excision/methods

KW - Lymphatic Metastasis

KW - Sentinel Lymph Node Biopsy

U2 - 10.1016/j.ctrv.2023.102556

DO - 10.1016/j.ctrv.2023.102556

M3 - Review article (Academic Journal)

C2 - 37126938

SN - 0305-7372

VL - 117

JO - Cancer Treatment Reviews

JF - Cancer Treatment Reviews

M1 - 102556

ER -

Uncertainties and controversies in axillary management of patients with breast cancer

Abstract

Bibliographical note

Keywords

UN SDGs

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