Weber, Walter P
Mayo Clinic
University of Basel, Basel, Switzerland.
Citations 2
Nodal Burden and Oncologic Outcomes in Patients With Residual Isolated Tumor Cells After Neoadjuvant Chemotherapy (ypN0i+): The OPBC-05/ICARO Study
Montagna, Giacomo , Laws, Alison , Ferrucci, Massimo , Mrdutt, Mary M., Sun, Susie X. , Bademler, Süleyman , Balbaloĝlu, Hakan , Balint‐Lahat, Nora, Banys-Paluchowski, Maggie, Barrio, Andrea V. , Benson, John R. , Beşe, Nuran , Boyle, Marissa K. , Diego, Emilia J. , Eden, Claire , Eller, Ruth S. , Goldschmidt, Maite, Hlavin, Callie , Heidinger, Martin , Jelinska, Justyna, Çakmak, Güldeniz Karadeniz , King, Tari A. , Kuerer, Henry M. , Loesch, Julie M, Milardi, Francesco , Murawa, Dawid , Moo, Tracy‐Ann , Menes, Tehillah S. , Passeri, Daniele , Pastoriza, Jessica , Perhavec, Andraž , Pislar, Nina , Polidorio, Natália , Rami, Avina , Ryu, Jai Min , Schulz, Alexandra , Sevilimedu, Varadan , Uğurlu, Mustafa Ümit , Uras, Cihan, Hemert, Annemiek K. E. van , Wong, Stephanie M. , Yoo, Tae-Kyung , Zhang, Jennifer Q. , Cabıoğlu, Neslihan , Peeters, Marie-Jeanne T. F. D. Vrancken , Morrow, Monica , Weber, William P. , Group, on behalf of the ICARO Study, Andreozzi, Mariacarla, Barbalho, Daniel Meirelles , Boileau, J.-F., Brogi, Edi , Cabero, Flávia Vidal, Cocco, Daniela , Bree, Eelco de , Vernet-Tomás, M. , Deutschmann, Christine , Ditsch, Nina, Fick, Franziska, Fitzal, Florian , Flanagan, Meghan R. , Gentile, Damiano , Grabenstetter, Anne , Heil, Jörg, Holtschmidt, Johannes , Krawczyk, Natalia , Kühn, Thorsten, Kümmel, Sherko, Muslumanoglu, Mahmut , Nekljudova, Valentina , Newman, Lisa A. , Poulakaki, Fiorita , Schwartz, Christopher J. , Siegel, Emily , Simonson, Colin , Tampaki, Ekaterini Christina , Tampakis, Athanasios , Tausch, Christoph, Bruele, Astrid Botty van den , Vorburger, Denise , Weiss, Anna, Wimmer, Kerstin , Woodward, Steven G. , Ziauddin, Firdos M., Boughey, JC , Boyle, Marissa K , Eller, Ruth , Heidinger, Martin , Karadeniz Cakmak, Güldeniz , Kesmodel, Susan B , King, Tari A , Milardi, Francesco , Murawa, Dawid , Menes, Tehillah S , Passeri, Daniele , Pastoriza, Jessica M , Perhavec, Andraz , Polidorio, Natália , Rami, Avina , Ugurlu, M Umit , van Hemert, Annemiek , Yoo, Tae-Kyung Robyn , Zhang, Jennifer Q , Peeters, Marie-Jeanne Vrancken , Morrow, Monica , Weber, Walter P , Wong, Stephanie M , Mrdutt, Mary M , Banys‐Paluchowski, Maggie , Boughey, Judy C. , Uras, Cihan , Karanlık, Hasan , Group, on behalf of the ICARO Study, Ahn, Sung Gwe , Corsi, Fabio , Crown, Angelena , Esposito, Emanuela , Fayanju, Oluwadamilola M. , Gentilini, Oreste D , Gülçelik, Mehmet Ali , Heil, Joerg , Leo, Cornelia , Pilewskie, Melissa , Riedel, Fabian , Rocco, Nicola , Schnabel, Freya Ruth , Singer, Christian F. , Soares, Leonardo Ribeiro , Tasoulis, Marios Konstantinos , Urban, Cicero A. , Vergauwen, Glenn , Wärnberg, Fredrik , Williams, Austin David
Journal of Clinical Oncology | November 7, 2024 | Volume: 43 | Issue: 7 | Pages: 810-820
PURPOSE The nodal burden of patients with residual isolated tumor cells (ITCs) in the sentinel lymph nodes (SLNs) after neoadjuvant chemotherapy (NAC) (ypN0i+) is unknown, and axillary management is not standardized. We investigated rates of additional positive lymph nodes (LNs) at axillary lymph node dissection (ALND) and oncologic outcomes in patients with ypN0i+ treated with and without ALND. METHODS The Oncoplastic Breast Consortium-05/ICARO cohort study (ClinicalTrials.gov identifier: NCT06464341 ) retrospectively analyzed data from patients with stage I to III breast cancer with ITCs in SLNs after NAC from 62 centers in 18 countries. The primary end point was the 3-year rate of any axillary recurrence. The rate of any invasive recurrence was the secondary end point. RESULTS In total, 583 patients were included, of whom 182 (31%) had completion ALND and 401 (69%) did not. The median age was 48 years. Most patients (74%) were clinically node-positive at diagnosis and 41% had hormone receptor–positive/human epidermal growth factor receptor 2–negative tumors. The mean number of SLNs with ITCs was 1.2. Patients treated with ALND were more likely to present with cN2/3 disease (17% v 7%, P < .001), have ITCs detected on frozen section (62% v 8%, P < .001), have lymphovascular invasion (38% v 24%, P < .001), and receive adjuvant chest wall (89% v 78%, P = .024) and nodal radiation (82% v 75%, P = .038). Additional positive nodes were found at ALND in 30% of patients, but only 5% had macrometastases. The 3-year rates of any axillary and any invasive recurrence were 2% (95% CI, 0.95 to 3.6) and 11% (95% CI, 8 to 14), respectively, with no statistical difference by type of axillary surgery. CONCLUSION The nodal burden in patients with ypN0(i+) was low, and axillary recurrence after ALND omission was rare in patients selected for this approach. These results do not support routine ALND in all patients with ypN0(i+).
Omission of Axillary Dissection Following Nodal Downstaging With Neoadjuvant Chemotherapy
Montagna, Giacomo , Mrdutt, Mary M., Hlavin, Callie , Diego, Emilia J. , Wong, Stephanie M. , Barrio, Andrea V. , Bruele, Astrid Botty van den , Cabıoğlu, Neslihan , Sevilimedu, Varadan , Hwang, E. Shelley, Ingham, Abigail, Papassotiropoulos, Bärbel , Nguyen-Sträuli, Bich Doan , Kurzeder, Christian , Aybar, Danilo Díaz, Vorburger, Denise , Matlac, Dieter Michael, Fitzal, Florian , Meani, Francesco , Fick, Franziska, Sagasser, Jacqueline, Heil, Jörg, Dedes, Konstantin J. , Romics, László , Banys‐Paluchowski, Maggie , Müslümanoğlu, Mahmut , Pérez, María del Rosario Cueva, Díaz, Marcelo Chávez , Heidinger, Martin , Fehr, Mathias K. , Tükenmez, Mustafa , Maggi, Nadia , Ditsch, Nina , Zarhi, Sebastián Solé, Küemmel, Sherko , Bruz̆as, S., Lascio, Simona Di , Parissenti, Tamara K., Güth, Uwe , Ovalle, Valentina , Tausch, Christoph, Kuerer, Henry M. , Caudle, Abigail S. , Boileau, Jean-François , Kühn, Thorsten, Morrow, Monica , Weber, William P. , Hoskin, Tanya L. , Heidinger, Martin , Weber, Walter P , Wong, Stephanie M , Mrdutt, Mary M , Sun, Susie X. , Rosenberger, Laura H. , Matlac, Dieter Michael , Ostapenko, Edvin , Riedel, Fabian , Heil, Jörg, Karanlık, Hasan , Reinisch, Mattea , Rocco, Nicola , Gentilini, Oreste D , Paulinelli, Régis Resende , Boughey, Judy C.
JAMA Oncology | April 25, 2024 | Volume: 10 | Issue: 6 | Pages: 793
ImportanceData on oncological outcomes after omission of axillary lymph node dissection (ALND) in patients with breast cancer that downstages from node positive to negative with neoadjuvant chemotherapy are sparse. Additionally, the best axillary surgical staging technique in this scenario is unknown.ObjectiveTo investigate oncological outcomes after sentinel lymph node biopsy (SLNB) with dual-tracer mapping or targeted axillary dissection (TAD), which combines SLNB with localization and retrieval of the clipped lymph node.Design, Setting, and ParticipantsIn this multicenter retrospective cohort study that was conducted at 25 centers in 11 countries, 1144 patients with consecutive stage II to III biopsy-proven node-positive breast cancer were included between April 2013 and December 2020. The cumulative incidence rates of axillary, locoregional, and any invasive (locoregional or distant) recurrence were determined by competing risk analysis.ExposureOmission of ALND after SLNB or TAD.Main Outcomes and MeasuresThe primary end points were the 3-year and 5-year rates of any axillary recurrence. Secondary end points included locoregional recurrence, any invasive (locoregional and distant) recurrence, and the number of lymph nodes removed.ResultsA total of 1144 patients (median [IQR] age, 50 [41-59] years; 78 [6.8%] Asian, 105 [9.2%] Black, 102 [8.9%] Hispanic, and 816 [71.0%] White individuals; 666 SLNB [58.2%] and 478 TAD [41.8%]) were included. A total of 1060 patients (93%) had N1 disease, 619 (54%) had ERBB2 (formerly HER2)–positive illness, and 758 (66%) had a breast pathologic complete response. TAD patients were more likely to receive nodal radiation therapy (85% vs 78%; P = .01). The clipped node was successfully retrieved in 97% of TAD cases and 86% of SLNB cases (without localization). The mean (SD) number of sentinel lymph nodes retrieved was 3 (2) vs 4 (2) (P &lt; .001), and the mean (SD) number of total lymph nodes removed was 3.95 (1.97) vs 4.44 (2.04) (P &lt; .001) in the TAD and SLNB groups, respectively. The 5-year rates of any axillary, locoregional, and any invasive recurrence in the entire cohort were 1.0% (95% CI, 0.49%-2.0%), 2.7% (95% CI, 1.6%-4.1%), and 10% (95% CI, 8.3%-13%), respectively. The 3-year cumulative incidence of axillary recurrence did not differ between TAD and SLNB (0.5% vs 0.8%; P = .55).Conclusions and RelevanceThe results of this cohort study showed that axillary recurrence was rare in this setting and was not significantly lower after TAD vs SLNB. These results support omission of ALND in this population.