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Cipolla C, Gebbia V, D’Agati E, Greco M, Mesi C, Scandurra G, Valerio MR. Comprehensive Axillary Management of Clinically Node-Positive (cN+) Breast Cancer Patients: A Narrative Review on Neoadjuvant Chemotherapy. Cancers (Basel) 2024; 16:3354. [PMID: 39409973 PMCID: PMC11482584 DOI: 10.3390/cancers16193354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 09/23/2024] [Accepted: 09/27/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND In breast cancer (BC) patients, axillary management has undergone major improvements over the last few years, and efforts to identify the optimal strategy for the management of axillary surgery are still ongoing. METHODS In current clinical practice, women with clinically node-positive (cN+) BC usually receive neoadjuvant chemotherapy (NACT) with the aim of reducing the extent of primary disease and, thus, allowing for axillary-conservative surgery. Remarkably, after NACT, up to one out of three patients achieves an axillary pathologic complete response, which, in turn, is associated with a more favorable prognosis than residual axillary disease. However, NACT is not without drawbacks, as NACT-associated inflammation can damage lymphatic vessels. Furthermore, varying degrees of response may occur in the axillary lymph nodes, increasing the false negative rate for sentinel biopsy. RESULTS At present, there is no consensus on the optimal approach in patients with cN+ BC undergoing NACT, although multidisciplinary management seems to be recommended. CONCLUSIONS This narrative review provides a comprehensive overview of axillary management in cN+ BC patients undergoing NACT. It uses a multidisciplinary approach that encompasses the oncological management perspectives, as well as surgical and chemotherapeutic viewpoints.
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Affiliation(s)
- Calogero Cipolla
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90100 Palermo, Italy; (C.C.); (E.D.); (M.G.); (C.M.); (M.R.V.)
- Breast Unit, AOUP Policlinico Paolo Giaccone, 90100 Palermo, Italy
| | - Vittorio Gebbia
- Department of Medicine and Surgery, Kore University of Enna, 94100 Enna, Italy;
- Medical Oncology Unit, Cdc Torina, 90100 Palermo, Italy
| | - Eleonora D’Agati
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90100 Palermo, Italy; (C.C.); (E.D.); (M.G.); (C.M.); (M.R.V.)
- Medical Oncology Unit, AOUP Policlinico Paolo Giaccone, 90100 Palermo, Italy
| | - Martina Greco
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90100 Palermo, Italy; (C.C.); (E.D.); (M.G.); (C.M.); (M.R.V.)
- Medical Oncology Unit, AOUP Policlinico Paolo Giaccone, 90100 Palermo, Italy
| | - Chiara Mesi
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90100 Palermo, Italy; (C.C.); (E.D.); (M.G.); (C.M.); (M.R.V.)
- Medical Oncology Unit, AOUP Policlinico Paolo Giaccone, 90100 Palermo, Italy
| | - Giuseppa Scandurra
- Department of Medicine and Surgery, Kore University of Enna, 94100 Enna, Italy;
- Medical Oncology Unit, Ospedale Cannizzaro, 95126 Catania, Italy
| | - Maria Rosaria Valerio
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90100 Palermo, Italy; (C.C.); (E.D.); (M.G.); (C.M.); (M.R.V.)
- Medical Oncology Unit, AOUP Policlinico Paolo Giaccone, 90100 Palermo, Italy
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Cardoso MJ, Poortmans P, Senkus E, Gentilini OD, Houssami N. Breast cancer highlights from 2023: Knowledge to guide practice and future research. Breast 2024; 74:103674. [PMID: 38340683 PMCID: PMC10869942 DOI: 10.1016/j.breast.2024.103674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 12/31/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
This narrative work highlights a selection of published work from 2023 with potential implications for breast cancer practice. We feature publications that have provided new knowledge immediately relevant to patient care or for future research. We also highlight guidelines that have reported evidence-based or consensus recommendations to support practice and evaluation in breast cancer diagnosis and treatment. The scope of selected highlights represents various domains and disciplines in cancer control, from prevention to treatment of early and advanced breast cancer.
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Affiliation(s)
- Maria-Joao Cardoso
- Champalimaud Foundation Breast Unit, Lisbon, Portugal; University of Lisbon, Faculty of Medicine, Lisbon, Portugal.
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk-Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Elżbieta Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Poland
| | - Oreste D Gentilini
- Università Vita-Salute San Raffaele, Milano, Italy; IRCCS Ospedale San Raffaele, Milano, Italy
| | - Nehmat Houssami
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia; Wiser Healthcare, The University of Sydney, Sydney, NSW, Australia
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