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 prior-itized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Sub-sequently, 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, fol-lowed 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 pro-spective register.

Uncertainties and controversies in axillary management of patients with breast cancer / Weber, Walter P; Davide Gentilini, Oreste; Morrow, Monica; Montagna, Giacomo; de Boniface, Jana; Fitzal, Florian; Wyld, Lynda; Rubio, Isabel T.; Matrai, Zoltan; King, Tari A.; Saccilotto, Ramon; Galimberti, Viviana; Maggi, Nadia; Andreozzi, Mariacarla; Sacchini, Virgilio; Castrezana López, Liliana; Loesch, Julie; Schwab, Fabienne D.; Eller, Ruth; Heidinger, Martin; Haug, Martin; Kurzeder, Christian; Di Micco, Rosa; Banys-Paluchowski, Maggie; Ditsch, Nina; Harder, Yves; Paulinelli, Régis R.; Urban, Cicero; Benson, John; Bjelic-Radisic, Vesna; Potter, Shelley; Knauer, Michael; Thill, Marc; Vrancken Peeters, Marie-Jeanne; Kuemmel, Sherko; Heil, Joerg; Gulluoglu, Bahadir M.; Tausch, Christoph; Ganz-Blaettler, Ursula; Shaw, Jane; Dubsky, Peter; Poortmans, Philip; Kaidar-Person, Orit; Kühn, Thorsten; Gnant, Michael. - In: CANCER TREATMENT REVIEWS. - ISSN 0305-7372. - 117:(2023). [10.1016/j.ctrv.2023.102556]

Uncertainties and controversies in axillary management of patients with breast cancer

Davide Gentilini, Oreste
Co-primo
;
2023-01-01

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 prior-itized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Sub-sequently, 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, fol-lowed 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 pro-spective register.
2023
Axillary dissection
Breast cancer
Breast surgery
Radiotherapy
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/159897
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