Will Targeted Axillary Surgery Suffice for Adjuvant Treatment Decision-Making?

Menée sur 500 patients atteints d'un cancer du sein avec envahissement ganglionnaire et inclus dans un essai européen de phase III (âge médian : 57 ans ; 97,4 % de femmes), cette étude examine le rôle d'un curage ganglionnaire axillaire dans la décision thérapeutique

Résumé en anglais

Weber and colleagues have published the results of a preplanned prospective observational cohort study of the first 500 randomized patients in the international, multicenter, phase 3 Tailored Axillary Surgery With or Without Axillary Lymph Node Dissection Followed by Radiotherapy in Patients With Clinically Node-Positive Breast Cancer (TAXIS) trial. This substudy was designed to address the association of staging information gleaned from axillary lymph node dissection (ALND) with adjuvant systemic therapy treatment decisions in 2 groups of patients with breast cancer: (1) patients with clinically node (cN)–positive breast cancer who undergo upfront surgery and (2) patients with cN-positive breast cancer and persistent nodal disease after neoadjuvant chemotherapy (NACT). For this study, the analytic cohort consisted of patients who underwent targeted axillary surgery (TAS), defined as removal of sentinel and palpable lymph nodes, from August 2018 through June 2022. The authors found that although omission of ALND in the patients who only received TAS plus axillary radiotherapy led to understaging of patients with cN-positive disease and significant axillary tumor burden, not knowing the exact number of positive nodes was not significantly associated with adjuvant treatment decisions in either recipients of NACT or upfront surgery, even if involved lymph nodes were, by implication, left behind.