Updates in Surgical Management of the Axilla.

IF 1.8 4区 医学 Q3 ONCOLOGY
Anita Mamtani, Andrea V Barrio
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引用次数: 0

Abstract

Over the past 3 decades, axillary management in patients with breast cancer has evolved dramatically. The introduction and increasing use of sentinel lymph node biopsy (SLNB) have revolutionized the surgical approach for many patients with early breast cancer, permitting appropriate axillary staging without compromising prognosis and conferring significantly less morbidity than axillary lymph node dissection (ALND). For patients with clinically node-negative breast cancer and pathologically negative nodes or limited nodal metastases who have up-front surgery followed by radiotherapy, SLNB alone is now the standard of care, as it is for many patients who are clinically node positive and achieve a nodal pathologic complete response to neoadjuvant therapy. Omission of SLNB is also becoming possible for many patients with early-stage hormone receptor-positive/HER2-negative clinically node-negative breast cancer, with a large randomized trial demonstrating noninferiority of omission of axillary surgery to SLNB. Conversely, for those with residual nodal disease after neoadjuvant chemotherapy or those with a clinically positive axilla who have up-front surgery, ALND remains indicated, although clinical trials evaluating de-escalation of axillary surgery in these patient subsets are ongoing. As multidisciplinary treatment paradigms become increasingly nuanced, it is crucial that systemic therapy treatment decisions for patients with early-stage breast cancer be based on the available pathologic nodal status provided by SLNB, without the need for ALND to find additional positive nodes. Here we review recent advances and ongoing controversies in the modern surgical management of the axilla in breast cancer.

在过去的 30 年中,乳腺癌患者的腋窝治疗发生了巨大的变化。前哨淋巴结活检(SLNB)的引入和越来越多的使用彻底改变了许多早期乳腺癌患者的手术方法,在不影响预后的情况下进行适当的腋窝分期,其发病率明显低于腋窝淋巴结清扫术(ALND)。对于临床结节阴性、病理结节阴性或有局限性结节转移、先手术后放疗的乳腺癌患者,单纯 SLNB 是目前的标准治疗方法,许多临床结节阳性且对新辅助治疗有结节病理完全反应的患者也是如此。对于许多激素受体阳性/HER2 阴性的早期临床结节阴性乳腺癌患者来说,省略 SLNB 也已成为可能,一项大型随机试验表明,省略腋窝手术的效果并不优于 SLNB。相反,对于新辅助化疗后有结节残留的患者或腋窝临床阳性并进行了前期手术的患者,ALND仍是首选,但对这些患者进行腋窝手术降级评估的临床试验仍在进行中。随着多学科治疗模式变得越来越细微,早期乳腺癌患者的全身治疗决策必须基于 SLNB 提供的病理结节状态,而无需通过 ALND 来发现其他阳性结节。在此,我们回顾了现代乳腺癌腋窝手术治疗的最新进展和持续争议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Oncology-New York
Oncology-New York 肿瘤学-肿瘤学
CiteScore
1.60
自引率
0.00%
发文量
69
审稿时长
6-12 weeks
期刊介绍: Although laboratory and clinical cancer research need to be closely linked, observations at the basic level often remain removed from medical applications. This journal works to accelerate the translation of experimental results into the clinic, and back again into the laboratory for further investigation. The fundamental purpose of this effort is to advance clinically-relevant knowledge of cancer, and improve the outcome of prevention, diagnosis and treatment of malignant disease. The journal publishes significant clinical studies from cancer programs around the world, along with important translational laboratory findings, mini-reviews (invited and submitted) and in-depth discussions of evolving and controversial topics in the oncology arena. A unique feature of the journal is a new section which focuses on rapid peer-review and subsequent publication of short reports of phase 1 and phase 2 clinical cancer trials, with a goal of insuring that high-quality clinical cancer research quickly enters the public domain, regardless of the trial’s ultimate conclusions regarding efficacy or toxicity.
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