Search

Your search keyword '"Clinically node-positive"' showing total 2 results
Start Over Descriptor "Clinically node-positive" Topic breast cancer
2 results on '"Clinically node-positive"'

1. Higher risk tumor features are not associated with higher nodal stage in patients with estrogen receptor-positive, node-positive breast cancer.

Author

Ye, Linda, Rünger, Dennis, Angarita, Stephanie A., Hadaya, Joseph, Baker, Jennifer L., Lee, Minna K., Thompson, Carlie K., Attai, Deanna J., and DiNome, Maggie L.

Abstract

Introduction: Studies support omission of axillary lymph node dissection (ALND) for patients with sentinel node-positive disease, with ALND recommended for patients who present with clinically positive nodes. Here, we evaluate patient and tumor characteristics and pathologic nodal stage of patients with estrogen receptor-positive (ER +) breast cancer who undergo ALND to determine if differences exist based on nodal presentation. Materials and methods: Retrospective chart review from 2010 to 2019 defined three groups of patients with ER + breast cancer who underwent ALND for positive nodes: SLN + (positive node identified at SLN biopsy), cNUS (abnormal preoperative US and biopsy), and cNpalp (palpable adenopathy). Patients who received neoadjuvant chemotherapy or presented with axillary recurrence were excluded. Results: Of 191 patients, 94 were SLN + , 40 were cNUS, and 57 were cNpalp. Patients with SLN + compared with cNpalp were younger (56 vs 64 years, p < 0.01), more often pre-menopausal (41% vs 14%, p < 0.01), and White (65% vs 39%, p = 0.01) with more tumors that were low-grade (36% vs 8%, p < 0.01). Rates of PR + (p = 0.16), levels of Ki67 expression (p = 0.07) and LVI (p = 0.06) did not differ significantly among groups. Of patients with SLN + disease, 64% had pN1 disease compared to 38% of cNUS (p = 0.1) and 40% of cNpalp (p = 0.01). On univariable analysis, tumor size (p = 0.01) and histology (p = 0.04) were significantly associated with pN1 disease, with size remaining an independent predictor on multivariable analysis (p = 0.02). Conclusion: Historically, higher risk features have been attributed to patients with clinically positive nodes precluding omission of ALND, but when restricting evaluation to patients with ER + breast cancer, only tumor size is associated with higher nodal stage. [ABSTRACT FROM AUTHOR]

Published
2022
Full Text
View/download PDF

2. Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): study protocol for a multicenter, randomized phase-III trial

Author

Daniel R. Zwahlen, Andreas Gyr, Markus Ackerknecht, Karin Ribi, Michael Knauer, Christian Kurzeder, Hanne Hawle, Zoltan Matrai, Thomas Ruhstaller, Michael Gnant, Simone Muenst, Marie Aline Gérard, Bettina Ballardini, Florian Fitzal, Guido Henke, Walter P. Weber, and Stefanie Hayoz

Subjects
Quality of life, medicine.medical_specialty, Time Factors, Disease-free survival, medicine.medical_treatment, Sentinel lymph node, Medicine (miscellaneous), Breast Neoplasms, Equivalence Trials as Topic, Mastectomy, Segmental, Tailored axillary surgery, law.invention, 03 medical and health sciences, Study Protocol, 0302 clinical medicine, Breast cancer, Randomized controlled trial, law, Risk Factors, Axillary lymph node dissection, medicine, Humans, Pharmacology (medical), Axillary radiotherapy, Overall survival, 030212 general & internal medicine, Clinically node-positive, Randomized Controlled Trials as Topic, lcsh:R5-920, business.industry, Standard treatment, Axillary Lymph Node Dissection, medicine.disease, Surgery, Radiation therapy, Clinical trial, Europe, Breast cancer surgery, Treatment Outcome, Clinical Trials, Phase III as Topic, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Lymph Node Excision, Female, Radiotherapy, Adjuvant, business, lcsh:Medicine (General), Mastectomy
Abstract

Background Complete lymph node removal through conventional axillary dissection (ALND) has been standard treatment for breast cancer patients for almost a century. In the 1990s, however, and in parallel with the advent of the sentinel lymph node (SLN) procedure, ALND came under increasing scrutiny due to its association with significant patient morbidity. Several studies have since provided evidence to suggest omission of ALND, often in favor of axillary radiation, in selected clinically node-negative, SLN-positive patients, thus supporting the current trend in clinical practice. Clinically node-positive patients, by contrast, continue to undergo ALND in many cases, if only for the lack of studies re-assessing the indication for ALND in these patients. Hence, there is a need for a clinical trial to evaluate the optimal treatment for clinically node-positive breast cancer patients in terms of surgery and radiotherapy. The TAXIS trial is designed to fill this gap by examining in particular the value of tailored axillary surgery (TAS), a new technique for selectively removing positive lymph nodes. Methods In this international, multicenter, phase-III, non-inferiority, randomized controlled trial (RCT), including 34 study sites from four different countries, we plan to randomize 1500 patients to either receive TAS followed by ALND and regional nodal irradiation excluding the dissected axilla, or receive TAS followed by regional nodal irradiation including the full axilla. All patients undergo adjuvant whole-breast irradiation after breast-conserving surgery and chest-wall irradiation after mastectomy. The main objective of the trial is to test the hypothesis that treatment with TAS and axillary radiotherapy is non-inferior to ALND in terms of disease-free survival of clinically node-positive breast cancer patients in the era of effective systemic therapy and extended regional nodal irradiation. The trial was activated on 31 July 2018 and the first patient was randomized on 7 August 2018. Discussion Designed to test the hypothesis that TAS is non-inferior to ALND in terms of curing patients and preventing recurrences, yet is significantly superior in reducing patient morbidity, this trial may establish a new worldwide treatment standard in breast cancer surgery. If found to be non-inferior to standard treatment, TAS may significantly contribute to reduce morbidity in breast cancer patients by avoiding surgical overtreatment. Trial registration ClinicalTrials.gov, ID: NCT03513614. Registered on 1 May 2018. www.kofam.ch, ID: NCT03513614. Registered on 17 June 2018. EudraCT No.: 2018–000372-14. Electronic supplementary material The online version of this article (10.1186/s13063-018-3021-9) contains supplementary material, which is available to authorized users.

Published
2018

Catalog

Books, media, physical & digital resources
See catalog results