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De-escalation of axillary irradiation for early breast cancer – Has the time come?

2021-12Recensão Acesso aberto
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dc.contributor.authorSenkus, Elżbieta
dc.contributor.authorCardoso, Maria Joao
dc.contributor.authorKaidar-Person, Orit
dc.contributor.authorŁacko, Aleksandra
dc.contributor.authorMeattini, Icro
dc.contributor.authorPoortmans, Philip
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblElsevier
dc.date.accessioned2021-11-03T05:03:13Z
dc.date.available2021-11-03T05:03:13Z
dc.date.issued2021-12
dc.description.abstractIntroduction of sentinel lymph node biopsy, initially in clinically node-negative and subsequently in patients presenting with involved axilla and downstaged by primary systemic therapy, allowed for significant decrease in morbidity compared to axillary lymph node dissection. Concurrently, regional nodal irradiation was demonstrated to improve outcomes in most node-positive patients. Additionally, over the last decades, introduction of more effective systemic therapies has resulted in improvements not only at distant sites, but also in locoregional control, creating space for de-escalation of locoregional treatments. We discuss the data on de-escalation in axillary surgery and irradiation, both in patients undergoing upfront surgery and primary systemic therapy, with special emphasis on the feasibility of omission of nodal irradiation in patients undergoing primary systemic therapy. In view of the accumulating evidence, omission of axillary irradiation may be considered in clinically node-positive patients converting after primary systemic therapy to pathologically negative nodes on sentinel lymph node biopsy (preferably also with in-breast pCR), presenting with lower initial nodal stage, older age and were treated with breast-conserving surgery followed by whole breast irradiation. Omission of regional nodal irradiation in patients with aggressive tumor phenotypes achieving a pCR is under investigation. In patients undergoing preoperative endocrine therapy the adoption of axillary management strategies utilized in case of upfront surgery seems more suitable than those used in post chemotherapy-based primary systemic therapy setting.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent1145283
dc.identifier.doi10.1016/j.ctrv.2021.102297
dc.identifier.issn0305-7372
dc.identifier.otherPURE: 34467251
dc.identifier.otherPURE UUID: 173131c9-a668-4698-9637-4aba7ad6b1aa
dc.identifier.otherScopus: 85116906438
dc.identifier.otherPubMed: 34656018
dc.identifier.otherWOS: 000708666700002
dc.identifier.urihttp://hdl.handle.net/10362/127069
dc.identifier.urlhttps://www.scopus.com/pages/publications/85116906438
dc.language.isoeng
dc.peerreviewedyes
dc.subjectAxillary de-escalation
dc.subjectBreast cancer
dc.subjectPrimary systemic therapy
dc.subjectRadiation therapy
dc.subjectSentinel lymph node biopsy
dc.subjectOncology
dc.subjectRadiology Nuclear Medicine and imaging
dc.subjectSDG 3 - Good Health and Well-being
dc.titleDe-escalation of axillary irradiation for early breast cancer – Has the time come?en
dc.typereview
degois.publication.titleCancer Treatment Reviews
degois.publication.volume101
dspace.entity.typePublication
rcaap.rightsopenAccess

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