Tailored axillary surgery in patients with clinically node-positive breast cancer: Pre-planned feasibility substudy of TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101)

Publication

Tailored axillary surgery in patients with clinically node-positive breast cancer: Pre-planned feasibility substudy of TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101)

Journal Paper/Review - Sep 8, 2021

Knauer Michael, Winkler Jelena, Reinisch Mattea, Reitsamer Roland, Singer Christian F, Reisenberger Klaus, Hager Christopher, Fansa Hisham, Exner Ruth, Dubsky Peter, Berclaz Gilles, Leo Cornelia, Lam Giang Thanh, Fehr Mathias K, Naydina Tatiana, Heil Jörg, Egle Daniel, Lelièvre Loic, Markellou Pagona, Schulz Alexandra, Maggi Nadia, Nussbaumer Rahel, Fitzal Florian, Ostapenko Valerijus, Clerc Karine, Kohlik Magdalena, Dedes Konstantin J, Sarlos Dimitri, Muenst Simone, Ruhstaller Thomas, Maddox Charlotte, Seiler Stefanie, Zimmermann Frank, Gruber Günther, Zwahlen Daniel R, Henke Guido, Tausch Christoph, Hayoz Stefanie, Matrai Zoltan, Ackerknecht Markus, Kuemmel Sherko, Bjelic-Radisic Vesna, Maráz Robert, Gabriel Natalie, Fehr Peter M, Simonson Colin, Bucher Susanne, Becciolini Charles, Meyer Inna, Satler Rok, Vrieling Conny, Újhelyi Mihály, Kurzeder Christian, Weber Walter P

Citation

Knauer M, Winkler J, Reinisch M, Reitsamer R, Singer C, Reisenberger K, Hager C, Fansa H, Exner R, Dubsky P, Berclaz G, Leo C, Lam G, Fehr M, Naydina T, Heil J, Egle D, Lelièvre L, Markellou P, Schulz A, Maggi N, Nussbaumer R, Fitzal F, Ostapenko V, Clerc K, Kohlik M, Dedes K, Sarlos D, Muenst S, Ruhstaller T, Maddox C, Seiler S, Zimmermann F, Gruber G, Zwahlen D, Henke G, Tausch C, Hayoz S, Matrai Z, Ackerknecht M, Kuemmel S, Bjelic-Radisic V, Maráz R, Gabriel N, Fehr P, Simonson C, Bucher S, Becciolini C, Meyer I, Satler R, Vrieling C, Újhelyi M, Kurzeder C, Weber W. Tailored axillary surgery in patients with clinically node-positive breast cancer: Pre-planned feasibility substudy of TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101). Breast 2021; 60:98-110.

Type

Journal Paper/Review (English)

Journal

Breast 2021; 60

Publication Date

Sep 8, 2021

Issn Electronic

1532-3080

Pages

98-110

Brief description/objective

AIM
We developed tailored axillary surgery (TAS) to reduce the axillary tumor volume in patients with clinically node-positive breast cancer to the point where radiotherapy can control it. The aim of this study was to quantify the extent of tumor load reduction achieved by TAS.

METHODS
International multicenter prospective study embedded in a randomized trial. TAS is a novel pragmatic concept for axillary surgery de-escalation that combines palpation-guided removal of suspicious nodes with the sentinel procedure and, optionally, imaging-guided localization. Pre-specified study endpoints quantified surgical extent and reduction of tumor load.

RESULTS
A total of 296 patients were included at 28 sites in four European countries, 125 (42.2%) of whom underwent neoadjuvant chemotherapy (NACT) and 71 (24.0%) achieved nodal pathologic complete response. Axillary metastases were detectable only by imaging in 145 (49.0%) patients. They were palpable in 151 (51.0%) patients, of whom 63 underwent NACT and 21 had residual palpable disease after NACT. TAS removed the biopsied and clipped node in 279 (94.3%) patients. In 225 patients with nodal disease at the time of surgery, TAS removed a median of five (IQR 3-7) nodes, two (IQR 1-4) of which were positive. Of these 225 patients, 100 underwent ALND after TAS, which removed a median of 14 (IQR 10-17) additional nodes and revealed additional positive nodes in 70/100 (70%) of patients. False-negative rate of TAS in patients who underwent subsequent ALND was 2.6%.

CONCLUSIONS
TAS selectively reduced the tumor load in the axilla and remained much less radical than ALND.