Changes in Surgical Management of the Axilla Over 11 Years - Report on More Than 1500 Breast Cancer Patients Treated with Neoadjuvant Chemotherapy on the Prospective I-SPY2 Trial.
Annals of surgical oncology : the official journal of the Society of Surgical Oncology
washington; swedish; swedish cancer
BACKGROUND: Axillary surgery after neoadjuvant chemotherapy (NAC) is becoming less extensive. We evaluated the evolution of axillary surgery after NAC on the multi-institutional I-SPY2 prospective trial.
METHODS: We examined annual rates of sentinel lymph node (SLN) surgery with resection of clipped node, if present), axillary lymph node dissection (ALND), and SLN and ALND in patients enrolled in I-SPY2 from January 1, 2011 to December 31, 2021 by clinical N status at diagnosis and pathologic N status at surgery. Cochran-Armitage trend tests were calculated to evaluate patterns over time.
RESULTS: Of 1578 patients, 973 patients (61.7%) had SLN-only, 136 (8.6%) had SLN and ALND, and 469 (29.7%) had ALND-only. In the cN0 group, ALND-only decreased from 20% in 2011 to 6.25% in 2021 (p = 0.0078) and SLN-only increased from 70.0% to 87.5% (p = 0.0020). This was even more striking in patients with clinically node-positive (cN+) disease at diagnosis, where ALND-only decreased from 70.7% to 29.4% (p < 0.0001) and SLN-only significantly increased from 14.6% to 56.5% (p < 0.0001). This change was significant across subtypes (HR-/HER2-, HR+/HER2-, and HER2+). Among pathologically node-positive (pN+) patients after NAC (n = 525) ALND-only decreased from 69.0% to 39.2% (p < 0.0001) and SLN-only increased from 6.9% to 39.2% (p < 0.0001).
CONCLUSIONS: Use of ALND after NAC has significantly decreased over the past decade. This is most pronounced in cN+ disease at diagnosis with an increase in the use of SLN surgery after NAC. Additionally, in pN+ disease after NAC, there has been a decrease in use of completion ALND, a practice pattern change that precedes results from clinical trials.
Women & Children
Boughey, Judy C; Yu, Hongmei; Dugan, Catherine Lu; Piltin, Mara A; Postlewait, Lauren; Son, Jennifer D; Edmiston, Kirsten K; Godellas, Constantine V; Lee, Marie C; Carr, Michael J; Tonneson, Jennifer E; Crown, Angelena; Lancaster, Rachel B; Woriax, Hannah E; Ewing, Cheryl A; Chau, Harrison S; Patterson, Anne K; Wong, Jasmine M; Alvarado, Michael D; Yang, Rachel L; Chan, Theresa W; Sheade, Jori B; Ahrendt, Gretchen M; Larson, Kelsey E; Switalla, Kayla; Tuttle, Todd M; Tchou, Julia C; Rao, Roshni; Tamirisa, Nina; Singh, Puneet; Gould, Rebekah E; Terando, Alicia; Sauder, Candice; Hewitt, Kelly; Chiba, Akiko; Esserman, Laura J; and Mukhtar, Rita A, "Changes in Surgical Management of the Axilla Over 11 Years - Report on More Than 1500 Breast Cancer Patients Treated with Neoadjuvant Chemotherapy on the Prospective I-SPY2 Trial." (2023). Articles, Abstracts, and Reports. 7709.