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Freitas-Junior R, de Oliveira VM, Frasson AL, Cavalcante FP, Mansani FP, Mattar A, Zerwes FP, de Oliveira Freitas AM, de Souza ABA, Damin AP, dos Santos AMR, Ruiz CA, de Lucena CÊM, Millen EC, Bagnoli F, Andrade F, Rodrigues FLB, Facina G, Novita G, Pedrini JL, Guará JP, Soares LR, de Nigro Corpa MV, Passos M, de Lucena Ferreira NCF, Freitas NMA, Machado RHS, da Cunha Amaral RK, Reinert T, Budel VM. Management of early-stage triple-negative breast cancer: recommendations of a panel of experts from the Brazilian Society of Mastology. BMC Cancer 2022; 22:1201. [PMID: 36419031 PMCID: PMC9682792 DOI: 10.1186/s12885-022-10250-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is a heterogenous subtype involving different patterns of behavior and clinical course, demanding a complex, individualized sequence of treatment. The knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology regarding TNBC were evaluated and a consensus regarding management and treatment was reached. METHODS Affiliates completed a survey involving 44 objective questions. In addition, a specialist meeting was held with 27 experts and 3 ad hoc consultants. The panelists completed the survey before and after brainstorming. Answers achieving 70% of agreement were considered consensual. The chi-square test was used to compare answers between panelists and affiliates and the Kappa coefficient to calculate agreement. RESULTS Consensus among the panelists increased from 26 (59.1%) to 32 questions (72.7%) following brainstorming (p = 0.17), including 7/10 questions on systemic treatment. Among the affiliates, consensus was achieved for 24 questions (54.5%), resulting in moderate agreement (κ = 0.445). Neoadjuvant chemotherapy should be indicated for almost all cases (except cT1a-b N0) and should include platinum agents. When indicated, immunotherapy is part of the standard of care. The panel reaffirmed the concept of no ink on tumor as indicative of adequate margins and the possibility of sentinel lymph node biopsy for cN1 patients who become cN0 following neoadjuvant therapy. Controversies remain on combining immunotherapy with capecitabine/olaparib in pertinent cases. CONCLUSION Expert consensus was achieved for > 70% of the questions, with moderate agreement between panelists and affiliates. Educational interventions on systemic breast cancer treatment affected decision-making in 60% of the questions.
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Affiliation(s)
- Ruffo Freitas-Junior
- grid.411195.90000 0001 2192 5801Advanced Center for Breast Diagnosis (CORA), Federal University of Goiás and the Araújo Jorge Hospital, Goiás Association for the Combat of Cancer, 1ª Avenida, s/n, Setor Universitário, Goiânia, GO 74605-050 Brazil
| | - Vilmar Marques de Oliveira
- grid.419432.90000 0000 8872 5006School of Medical Sciences, Santa Casa de Misericórdia de São Paulo, São Paulo, SP Brazil
| | - Antonio Luiz Frasson
- grid.413562.70000 0001 0385 1941Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (RS), Brazil and the Hospital Israelita Albert Einstein, São Paulo, SP Brazil
| | | | - Fabio Postiglione Mansani
- grid.412323.50000 0001 2218 3838Department of Medicine, State University of Ponta Grossa, Ponta Grossa, PR Brazil
| | - André Mattar
- grid.459930.2Reference Center in Women’s Health Care, Pérola Byington Hospital, São Paulo, SP Brazil
| | - Felipe Pereira Zerwes
- grid.412519.a0000 0001 2166 9094Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | | | | | - Andrea P. Damin
- grid.8532.c0000 0001 2200 7498Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | | | - Carlos Alberto Ruiz
- grid.11899.380000 0004 1937 0722Teaching Hospital, School of Medicine, University of São Paulo, São Paulo, SP Brazil
| | | | | | - Fábio Bagnoli
- grid.419432.90000 0000 8872 5006School of Medical Sciences, Santa Casa de Misericórdia de São Paulo and the Hospital Israelita Albert Einstein, São Paulo, SP Brazil
| | - Felipe Andrade
- grid.413471.40000 0000 9080 8521Department of Breast Surgery, Hospital Sírio-Libanês, São Paulo, SP Brazil
| | | | - Gil Facina
- grid.411249.b0000 0001 0514 7202Department of Gynecology, Federal University of São Paulo, São Paulo, SP Brazil
| | - Guilherme Novita
- grid.413562.70000 0001 0385 1941Hospital Israelita Albert Einstein, São Paulo, SP Brazil
| | | | - José Pereira Guará
- grid.411204.20000 0001 2165 7632Teaching Hospital of the Federal University of Maranhão, São Luís, MA Brazil
| | - Leonardo Ribeiro Soares
- grid.411195.90000 0001 2192 5801Advanced Center for Breast Diagnosis (CORA), Federal University of Goiás and the Dona Iris Women’s and Maternity Hospital, Goiânia, GO Brazil
| | | | - Mauro Passos
- grid.414433.5Hospital de Base, Federal District, Brasília, DF Brazil
| | | | - Nilceana Maya Aires Freitas
- Radiotherapy Unit, Araújo Jorge Cancer Hospital, Goiás Association for the Combat of Cancer, and Brazilian Center for Radiotherapy, Oncology and Mastology (CEBROM), Goiânia, GO Brazil
| | | | | | - Tomás Reinert
- Oncoclínicas Porto Alegre, Porto Alegre (RS) and the Serra Gaúcha Research Center, Caxias do Sul, RS Brazil
| | - Vinicius Milani Budel
- grid.20736.300000 0001 1941 472XTeaching Hospital of the Federal University of Paraná, Curitiba, PR Brazil
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Cavalcante FP, Zerwes F, Millen EC, Novita G, de Souza ABA, Reis JHP, de Oliveira Filho HR, de B L Limongi LN, de Assis Carvalho BPS, de Oliveira Freitas AM, Jourdan1 MT, de Oliveira VM, Freitas-Junior R. Management of the positive sentinel lymph node following neoadjuvant chemotherapy: results of a survey conducted with breast surgeons. Ecancermedicalscience 2022; 16:1357. [PMID: 35510139 PMCID: PMC9023305 DOI: 10.3332/ecancer.2022.1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Felipe Zerwes
- School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS 90450130, Brazil
- https://orcid.org/0000-0002-1643-727X
| | - Eduardo Camargo Millen
- Instituto Oncoclinicas, Rio de Janeiro, RJ 22440040, Brazil
- https://orcid.org/0000-0002-2113-6324
| | - Guilherme Novita
- Breast Unit, Hospital Israelita Albert Einstein, São Paulo, SP 01321001, Brazil
- https://orcid.org/0000-0003-2983-3199
| | | | - João Henrique Penna Reis
- Breast Center, Instituto Orizonti and Hospital Mater Dei, Belo Horizonte, Minas Gerais, MG 30210080, Brazil
- https://orcid.org/0000-0002-7754-9793
| | | | | | | | | | - Monica Travassos Jourdan1
- Breast Unit, Samaritano Botafogo (Américas Serviços Médicos), Rio de Janeiro, RJ 22270010, Brazil
- https://orcid.org/0000-0003-0910-0270
| | - Vilmar Marques de Oliveira
- School of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP 01224001, Brazil
- Breast Unit, Santa Casa de São Paulo, São Paulo, SP 01221010, Brazil
- https://orcid.org/0000-0002-9478-5616
| | - Ruffo Freitas-Junior
- CORA Advanced Centre for Diagnosis of Breast Cancer, Department of Obstetrics and Gynaecology, Federal University of Goiás, Goiânia, GO 74605050, Brazil
- https://orcid.org/0000-0003-4145-8598
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Millen EC, Cavalcante FP, Zerwes F, Novita G, de Souza ABA, Reis JHP, de Oliveira Filho HR, de B L Limongi LN, de Assis Carvalho BPS, de Oliveira Freitas AM, Jourdan MT, de Oliveira VM, Freitas-Junior R. ASO Visual Abstract: The Attitudes of Brazilian Breast Surgeons on Axillary Management in Early Breast Cancer 10 Years After the ACOSOG Z0011 Trial First Publication. Ann Surg Oncol 2021. [PMID: 34713374 DOI: 10.1245/s10434-021-10939-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Felipe Zerwes
- School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Guilherme Novita
- Breast Unit, Hospital Israelita Albert Einstein, América Serviços Médicos, São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | | | - Ruffo Freitas-Junior
- Department of Obstetrics and Gynecology, Federal University of Goiás, CORA Advanced Center for Diagnosis of Breast Cancer, Goiânia, GO, Brazil
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Millen EC, Cavalcante FP, Zerwes F, Novita G, de Souza ABA, Reis JHP, de Oliveira Filho HR, de B L Limongi LN, de Assis Carvalho BPS, de Oliveira Freitas AM, Jourdan MT, de Oliveira VM, Freitas-Junior R. The Attitudes of Brazilian Breast Surgeons on Axillary Management in Early Breast Cancer-10 Years after the ACOSOG Z0011 Trial First Publication. Ann Surg Oncol 2021; 29:1087-1095. [PMID: 34570334 DOI: 10.1245/s10434-021-10812-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/03/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the impact of the ACOSOG Z0011 trial on axillary breast cancer surgery management in Brazil following publication of that study (2010) and again in 2020. PATIENTS AND METHODS A survey of members of the Brazilian Society of Mastology. RESULTS Of 1627 breast surgeons, 799 (49.1%) completed and returned the questionnaire. For patients with the Z11 inclusion criteria, following detection of a positive sentinel lymph node (SLN), axillary dissection (AD) was recommended by 99.2% of respondents before publication of the study, 47.5% in 2010 and 18.5% in 2020 (p < 0.001). In breast-conserving surgery, if there were micro-metastases, 2.6% would perform AD, 30.3% axillary radiotherapy, and 67.1% no additional axillary treatment, while with macro-metastases, these proportions were 21.3%, 52.2%, and 26.5%, respectively. In cases of mastectomy and of nodal extracapsular extension, 43.4% and 36% of surgeons, respectively, recommended AD. For clinically negative axilla and suspicious findings at ultrasonography, 69% of the surgeons would apply the Z11 approach. Most applied the Z11 criteria in cases of younger patients (83.6%) and triple-negative and/or HER2 positive tumors (74%). AD was significantly more likely to be recommended by surgeons who did not work in academic institutes, who worked in locations other than capital cities, who were not board-certified, and who were ≥ 50 years old. CONCLUSIONS This survey revealed substantial changes in axillary surgery management in cN0/pathologically positive SLN, particularly following publication of the updated Z11 results and other similar studies. A better education environment and long-term follow-up were factors associated with the incorporation of Z11-related changes in practice.
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Affiliation(s)
| | | | - Felipe Zerwes
- School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Guilherme Novita
- Breast Unit, Hospital Israelita Albert Einstein, América Serviços Médicos, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Vilmar Marques de Oliveira
- School of Medical Sciences, Santa Casa de São Paulo, Head of the Breast Unit, Santa Casa de São Paulo, São Paulo, Brazil
| | - Ruffo Freitas-Junior
- Department of Obstetrics and Gynecology, CORA Advanced Center for Diagnosis of Breast Cancer, Federal University of Goiás, Goiânia, Brazil
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