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Montagna G, Mrdutt MM, Sun SX, Hlavin C, Diego EJ, Wong SM, Barrio AV, van den Bruele AB, Cabioglu N, Sevilimedu V, Rosenberger LH, Hwang ES, Ingham A, Papassotiropoulos B, Nguyen-Sträuli BD, Kurzeder C, Aybar DD, Vorburger D, Matlac DM, Ostapenko E, Riedel F, Fitzal F, Meani F, Fick F, Sagasser J, Heil J, Karanlık H, Dedes KJ, Romics L, Banys-Paluchowski M, Muslumanoglu M, Perez MDRC, Díaz MC, Heidinger M, Fehr MK, Reinisch M, Tukenmez M, Maggi N, Rocco N, Ditsch N, Gentilini OD, Paulinelli RR, Zarhi SS, Kuemmel S, Bruzas S, di Lascio S, Parissenti TK, Hoskin TL, Güth U, Ovalle V, Tausch C, Kuerer HM, Caudle AS, Boileau JF, Boughey JC, Kühn T, Morrow M, Weber WP. Omission of Axillary Dissection Following Nodal Downstaging With Neoadjuvant Chemotherapy. JAMA Oncol 2024:2817953. [PMID: 38662396 PMCID: PMC11046400 DOI: 10.1001/jamaoncol.2024.0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/07/2023] [Indexed: 04/26/2024]
Abstract
Importance Data on oncological outcomes after omission of axillary lymph node dissection (ALND) in patients with breast cancer that downstages from node positive to negative with neoadjuvant chemotherapy are sparse. Additionally, the best axillary surgical staging technique in this scenario is unknown. Objective To investigate oncological outcomes after sentinel lymph node biopsy (SLNB) with dual-tracer mapping or targeted axillary dissection (TAD), which combines SLNB with localization and retrieval of the clipped lymph node. Design, Setting, and Participants In this multicenter retrospective cohort study that was conducted at 25 centers in 11 countries, 1144 patients with consecutive stage II to III biopsy-proven node-positive breast cancer were included between April 2013 and December 2020. The cumulative incidence rates of axillary, locoregional, and any invasive (locoregional or distant) recurrence were determined by competing risk analysis. Exposure Omission of ALND after SLNB or TAD. Main Outcomes and Measures The primary end points were the 3-year and 5-year rates of any axillary recurrence. Secondary end points included locoregional recurrence, any invasive (locoregional and distant) recurrence, and the number of lymph nodes removed. Results A total of 1144 patients (median [IQR] age, 50 [41-59] years; 78 [6.8%] Asian, 105 [9.2%] Black, 102 [8.9%] Hispanic, and 816 [71.0%] White individuals; 666 SLNB [58.2%] and 478 TAD [41.8%]) were included. A total of 1060 patients (93%) had N1 disease, 619 (54%) had ERBB2 (formerly HER2)-positive illness, and 758 (66%) had a breast pathologic complete response. TAD patients were more likely to receive nodal radiation therapy (85% vs 78%; P = .01). The clipped node was successfully retrieved in 97% of TAD cases and 86% of SLNB cases (without localization). The mean (SD) number of sentinel lymph nodes retrieved was 3 (2) vs 4 (2) (P < .001), and the mean (SD) number of total lymph nodes removed was 3.95 (1.97) vs 4.44 (2.04) (P < .001) in the TAD and SLNB groups, respectively. The 5-year rates of any axillary, locoregional, and any invasive recurrence in the entire cohort were 1.0% (95% CI, 0.49%-2.0%), 2.7% (95% CI, 1.6%-4.1%), and 10% (95% CI, 8.3%-13%), respectively. The 3-year cumulative incidence of axillary recurrence did not differ between TAD and SLNB (0.5% vs 0.8%; P = .55). Conclusions and Relevance The results of this cohort study showed that axillary recurrence was rare in this setting and was not significantly lower after TAD vs SLNB. These results support omission of ALND in this population.
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Affiliation(s)
- Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mary M. Mrdutt
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Susie X. Sun
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Callie Hlavin
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Emilia J. Diego
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephanie M. Wong
- Department of Surgery, McGill University Medical School, Montreal, Quebec, Canada
- Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | - Andrea V. Barrio
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Neslihan Cabioglu
- Department of General Surgery, Istanbul Medical Faculty, Breast Surgery Service, Istanbul University, Istanbul, Turkey
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - E. Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Abigail Ingham
- University of Glasgow and National Health Service Greater Glasgow and Clyde, Department of Academic Surgery, Glasgow, Scotland
| | | | | | - Christian Kurzeder
- Breast Center, University Hospital of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Danilo Díaz Aybar
- Breast Service, Department of Surgery, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
| | - Denise Vorburger
- Breast Cancer Unit, Comprehensive Cancer Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Dieter Michael Matlac
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Edvin Ostapenko
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Breast Unit, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Francesco Meani
- Centro di Senologia della Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Gruppo Ospedaliero Moncucco, Ticino, Switzerland
| | - Franziska Fick
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Jacqueline Sagasser
- Department of Obstetrics and Gynecology, University Hospital of Augsburg, Augsburg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, Breast Unit, Heidelberg University Hospital, Heidelberg, Germany
| | - Hasan Karanlık
- Division of Surgical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | | | - Laszlo Romics
- University of Glasgow and National Health Service Greater Glasgow and Clyde, Department of Academic Surgery, Glasgow, Scotland
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Mahmut Muslumanoglu
- Department of General Surgery, Istanbul Medical Faculty, Breast Surgery Service, Istanbul University, Istanbul, Turkey
| | | | - Marcelo Chávez Díaz
- Breast Service, Department of Surgery, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
| | - Martin Heidinger
- Breast Center, University Hospital of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Mattea Reinisch
- Interdisciplinary Breast Cancer Center/Breast Unit, Kliniken Essen-Mitte, Germany
- Charité–Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Mustafa Tukenmez
- Department of General Surgery, Istanbul Medical Faculty, Breast Surgery Service, Istanbul University, Istanbul, Turkey
| | - Nadia Maggi
- Breast Center, University Hospital of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicola Rocco
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Nina Ditsch
- Department of Obstetrics and Gynecology, University Hospital of Augsburg, Augsburg, Germany
| | | | | | - Sebastián Solé Zarhi
- Department of Radiation Oncology, IRAM–Universidad Diego Portales, Santiago, Chile
| | - Sherko Kuemmel
- Interdisciplinary Breast Cancer Center/Breast Unit, Kliniken Essen-Mitte, Germany
- Charité–Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Simona Bruzas
- Interdisciplinary Breast Cancer Center/Breast Unit, Kliniken Essen-Mitte, Germany
| | - Simona di Lascio
- Centro di Senologia della Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | | | - Tanya L. Hoskin
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Uwe Güth
- Breast-Center Zurich AG, Zurich, Switzerland
| | - Valentina Ovalle
- Department of Radiation Oncology, IRAM–Universidad Diego Portales, Santiago, Chile
| | - Christoph Tausch
- Breast-Center Zurich AG, Zurich, Switzerland
- University of Basel, Basel, Switzerland
| | - Henry M. Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Abigail S. Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jean-Francois Boileau
- Department of Surgery, McGill University Medical School, Montreal, Quebec, Canada
- Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | - Judy C. Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Thorsten Kühn
- Department of Gynecology, Klinikum Esslingen, Esslingen, Germany
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Walter P. Weber
- Breast Center, University Hospital of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Maggi N, Rais D, Nussbaumer R, Levy J, Schwab FD, Kurzeder C, Heidinger M, Weber WP. The American Society of Breast Surgeons classification system for oncoplastic breast conserving surgery independently predicts the risk of delayed wound healing. Eur J Surg Oncol 2023; 49:107032. [PMID: 37619374 DOI: 10.1016/j.ejso.2023.107032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/05/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Oncoplastic breast conserving surgery (OBCS) aims to provide safe and satisfying surgery for breast cancer patients. The American Society of Breast Surgeons (ASBrS) classification system is based on volumetric displacement cut-offs (level I for <20% of breast volume; level II for 20-50%). It aims to facilitate communication among treating physicians and patients. Here, we investigate whether the extent of OBCS as classified by ASBrS independently predicts postoperative complications. MATERIALS AND METHODS This retrospective analysis of a prospectively maintained database included patients with stage I-III breast cancer who underwent OBCS between 03/2011 and 12/2020 at a Swiss university hospital. Outcomes included short-term (≤30 days) complications and chronic (>30 days) pain after surgery. Multivariate logistic regression models were used to identify independent predictors. RESULTS In total, 439 patients were included, 314 (71.5%) received ASBrS level I surgery, and 125 (28.5%) underwent ASBrS level II surgery. ASBrS level II was found to be an independent predictor of delayed wound healing (odds ratio [OR] 9.75, 95% confidence intervals (CI) 2.96-32.10). However, ASBrS level did not predict chronic postoperative pain (incidence rate ratio [IRR] 1.20, 95%CI 0.85-1.70), as opposed to age (IRR 1.19, 95%CI 1.11-1.27 per 5 years decrease), and weight disorders (underweight [BMI <18.5] vs. normal weight [BMI 18.5 < 25]: IRR 4.02, 95%CI 1.70-9.54; obese [BMI ≥30] vs. normal weight: IRR 2.07, 95%CI 1.37-3.13). CONCLUSION ASBrS level II surgery predicted delayed wound healing, warranting close clinical follow-up and prompt treatment to avoid delays in adjuvant therapy.
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Affiliation(s)
- Nadia Maggi
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
| | - Daniel Rais
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
| | - Rahel Nussbaumer
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Jeremy Levy
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Fabienne D Schwab
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
| | - Martin Heidinger
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
| | - Walter P Weber
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
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3
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Tausch C, Däster K, Hayoz S, Matrai Z, Fitzal F, Henke G, Zwahlen DR, Gruber G, Zimmermann F, Andreozzi M, Goldschmidt M, Schulz A, Maggi N, Saccilotto R, Heidinger M, Mueller A, Tampaki EC, Bjelic-Radisic V, Sávolt Á, Smanykó V, Hagen D, Müller DJ, Gnant M, Loibl S, Markellou P, Bekes I, Egle D, Ruhstaller T, Muenst S, Kuemmel S, Vrieling C, Satler R, Becciolini C, Bucher S, Kurzeder C, Simonson C, Fehr PM, Gabriel N, Maráz R, Sarlos D, Dedes KJ, Leo C, Berclaz G, Fansa H, Hager C, Reisenberger K, Singer CF, Montagna G, Reitsamer R, Winkler J, Lam GT, Fehr MK, Naydina T, Kohlik M, Clerc K, Ostapenko V, Lelièvre L, Heil J, Knauer M, Weber WP. Trends in use of neoadjuvant systemic therapy in patients with clinically node-positive breast cancer in Europe: prospective TAXIS study (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101). Breast Cancer Res Treat 2023; 201:215-225. [PMID: 37355526 PMCID: PMC10361860 DOI: 10.1007/s10549-023-06999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The aim of this study was to evaluate clinical practice heterogeneity in use of neoadjuvant systemic therapy (NST) for patients with clinically node-positive breast cancer in Europe. METHODS The study was preplanned in the international multicenter phase-III OPBC-03/TAXIS trial (ClinicalTrials.gov Identifier: NCT03513614) to include the first 500 randomized patients with confirmed nodal disease at the time of surgery. The TAXIS study's pragmatic design allowed both the neoadjuvant and adjuvant setting according to the preferences of the local investigators who were encouraged to register eligible patients consecutively. RESULTS A total of 500 patients were included at 44 breast centers in six European countries from August 2018 to June 2022, 165 (33%) of whom underwent NST. Median age was 57 years (interquartile range [IQR], 48-69). Most patients were postmenopausal (68.4%) with grade 2 and 3 hormonal receptor-positive and human epidermal growth factor receptor 2-negative breast cancer with a median tumor size of 28 mm (IQR 20-40). The use of NST varied significantly across the countries (p < 0.001). Austria (55.2%) and Switzerland (35.8%) had the highest percentage of patients undergoing NST and Hungary (18.2%) the lowest. The administration of NST increased significantly over the years (OR 1.42; p < 0.001) and more than doubled from 20 to 46.7% between 2018 and 2022. CONCLUSION Substantial heterogeneity in the use of NST with HR+/HER2-breast cancer exists in Europe. While stringent guidelines are available for its use in triple-negative and HER2+ breast cancer, there is a need for the development of and adherence to well-defined recommendations for HR+/HER2-breast cancer.
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Affiliation(s)
- Christoph Tausch
- Breast Center Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | | | - Zoltan Matrai
- Hamad Medical Corporation, Department of Oncoplastic Breast Surgery, Doha, Qatar
- International Breast Cancer Study Group - a division of ETOP IBCSG Partners Foundation, Bern, Switzerland
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Guido Henke
- Department of Radiation Oncology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
- Department of Radiation Oncology, Kantonsspital Münsterlingen/Spital Thurgau AG, Münsterlingen, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Günther Gruber
- Institute of Radiotherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Frank Zimmermann
- University of Basel, Basel, Switzerland
- Clinic of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Mariacarla Andreozzi
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Maite Goldschmidt
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Alexandra Schulz
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Nadia Maggi
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Ramon Saccilotto
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Martin Heidinger
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Andreas Mueller
- SAKK Competence Center, Bern, Switzerland
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Ekaterini Christina Tampaki
- Department of Plastic, Reconstructive Surgery and Burn Unit, KAT Athens Hospital and Trauma Center, Athens, Greece
| | | | - Ákos Sávolt
- National Institute of Oncology, Budapest, Hungary
| | | | - Daniela Hagen
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Michael Gnant
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Sibylle Loibl
- German Breast Group, GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - Pagona Markellou
- Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Inga Bekes
- Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel Egle
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Breast Cancer Center Tirol, Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Ruhstaller
- University of Basel, Basel, Switzerland
- Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Simone Muenst
- University of Basel, Basel, Switzerland
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Charité, Essen, Germany
- Department of Gynecology with Breast Center, Universitätsmedizin Berlin, Berlin, Germany
| | - Conny Vrieling
- Department of Radiation Oncology, Hirslanden Clinique des Grangettes, Geneva, Switzerland
| | - Rok Satler
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Charles Becciolini
- Breast Center, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Susanne Bucher
- Breast Center, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Christian Kurzeder
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Colin Simonson
- Department of Gynecology, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
| | - Peter M Fehr
- Breast Center Graubünden, Cantonal Hospital Graubünden, Chur, Switzerland
| | | | - Robert Maráz
- Department of Oncology, Bacs-Kiskun Country Hospital, Kecskemet, Hungary
| | - Dimitri Sarlos
- Breast Center, Cantonal Hospital Aarau, Aarau, Switzerland
| | | | - Cornelia Leo
- Breast Center, Cantonal Hospital Baden, Baden, Switzerland
| | | | - Hisham Fansa
- Breast Center Zürich, Bethanien & Spital Zollikerberg, Zurich, Switzerland
| | - Christopher Hager
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Department of Gynecology and Obstetrics, City Hospital, Dornbirn, Austria
| | - Klaus Reisenberger
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Department of Gynecology and Obstetrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Christian F Singer
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Department of Gynecology and Obstetrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Roland Reitsamer
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Breast Center, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | | - Giang Thanh Lam
- Breast Center, University Hospital of Geneva, Geneva, Switzerland
| | | | | | | | - Karine Clerc
- Brustzentrum Freiburg, Centre du Sein Fribourg, Fribourg, Switzerland
| | | | | | - Jörg Heil
- Breast Center Heidelberg, Heidelberg, Germany
| | - Michael Knauer
- Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Walter Paul Weber
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
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4
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Heidinger M, Maggi N, Dutilh G, Mueller M, Eller RS, Loesch JM, Schwab FD, Kurzeder C, Weber WP. Use of sentinel lymph node biopsy in elderly patients with breast cancer - 10-year experience from a Swiss university hospital. World J Surg Oncol 2023; 21:176. [PMID: 37287038 DOI: 10.1186/s12957-023-03062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/15/2023] [Accepted: 06/04/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The Choosing Wisely initiative recommended the omission of routine sentinel lymph node biopsy (SLNB) in patients ≥ 70 years of age, with clinically node-negative, early stage, hormone receptor (HR) positive and human epidermal growth factor receptor 2 (Her2) negative breast cancer in August 2016. Here, we assess the adherence to this recommendation in a Swiss university hospital. METHODS We conducted a retrospective single center cohort study from a prospectively maintained database. Patients ≥ 18 years of age with node-negative breast cancer were treated between 05/2011 and 03/2022. The primary outcome was the percentage of patients in the Choosing Wisely target group who underwent SLNB before and after the initiative went live. Statistical significance was tested using chi-squared test for categorical and Wilcoxon rank-sum tests for continuous variables. RESULTS In total, 586 patients met the inclusion criteria with a median follow-up of 2.7 years. Of these, 163 were ≥ 70 years of age and 79 were eligible for treatment according to the Choosing Wisely recommendations. There was a trend toward a higher rate of SLNB (92.7% vs. 75.0%, p = 0.07) after the Choosing Wisely recommendations were published. In patients ≥ 70 years with invasive disease, fewer received adjuvant radiotherapy after omission of SLNB (6.2% vs. 64.0%, p < 0.001), without differences concerning adjuvant systemic therapy. Both short-term and long-term complication rates after SLNB were low, without differences between elderly patients and those < 70 years. CONCLUSIONS Choosing Wisely recommendations did not result in a decreased use of SLNB in the elderly at a Swiss university hospital.
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Affiliation(s)
- Martin Heidinger
- Breast Center, University Hospital Basel, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Universitätsspital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Nadia Maggi
- Breast Center, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Gilles Dutilh
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | | | - Ruth S Eller
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Julie M Loesch
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Fabienne D Schwab
- Breast Center, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Walter P Weber
- Breast Center, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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5
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Weber WP, Davide Gentilini O, Morrow M, Montagna G, de Boniface J, Fitzal F, Wyld L, Rubio IT, Matrai Z, King TA, Saccilotto R, Galimberti V, Maggi N, Andreozzi M, Sacchini V, Castrezana López L, Loesch J, Schwab FD, Eller R, Heidinger M, Haug M, Kurzeder C, Di Micco R, Banys-Paluchowski M, Ditsch N, Harder Y, Paulinelli RR, Urban C, Benson J, Bjelic-Radisic V, Potter S, Knauer M, Thill M, Vrancken Peeters MJ, Kuemmel S, Heil J, Gulluoglu BM, Tausch C, Ganz-Blaettler U, Shaw J, Dubsky P, Poortmans P, Kaidar-Person O, Kühn T, Gnant M. Uncertainties and controversies in axillary management of patients with breast cancer. Cancer Treat Rev 2023; 117:102556. [PMID: 37126938 PMCID: PMC10752145 DOI: 10.1016/j.ctrv.2023.102556] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023]
Abstract
The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prioritized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Subsequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, followed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a prospective register.
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Affiliation(s)
- Walter P Weber
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | | | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Breast Unit, Capio St Göran's Hospital, Stockholm, Sweden
| | - Florian Fitzal
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Austria; Austrian Breast and Colorectal Study Group ABCSG, Vienna, Austria
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Isabel T Rubio
- Breast Surgical Oncology Unit, Clinica Universidad de Navarra, Madrid, Spain
| | - Zoltan Matrai
- Hamad Medical Corporation, Dept of Oncoplastic Breast Surgery, Doha, Qatar
| | - Tari A King
- Division of Breast Surgery, Brigham and Women's Hospital, Dana Farber/Brigham Cancer Center, Boston, MA, USA
| | - Ramon Saccilotto
- University of Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | | | - Nadia Maggi
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Mariacarla Andreozzi
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Virgilio Sacchini
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Julie Loesch
- Gynecology Department, University Hospital Zurich, Zurich, Switzerland
| | - Fabienne D Schwab
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Ruth Eller
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Martin Heidinger
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Martin Haug
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Rosa Di Micco
- Breast Surgery, San Raffaele University and Research Hospital, Milan, Italy
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Nina Ditsch
- Department of Gynaecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Régis R Paulinelli
- Federal University of Goias, Goias, Brazil; Breast Unit, Araújo Jorge Hospital, Goias, Brazil
| | - Cicero Urban
- Breast Unit, Hospital Nossa Senhora Das Graças, Curitiba, Brazil
| | - John Benson
- Cambridge Breast Unit, Addenbrooke's Hospital Cambridge, Cambridge, UK; Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation TRUST, School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Vesna Bjelic-Radisic
- Breast Unit, University Hospital Helios Wuppertal, University Witten/Herdecke, Wuppertal, Germany; Medical University Graz, Graz, Austria
| | | | - Michael Knauer
- Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Marc Thill
- Department of Gynaecology and Gynaecological Oncology, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Surgery, University Medical Center, Amsterdam, Netherlands
| | - Sherko Kuemmel
- Breast Unit, Hospital Essen-Mitte, Germany; Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Joerg Heil
- Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany
| | | | | | | | - Jane Shaw
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Peter Dubsky
- University of Lucerne, Faculty of Health Sciences and Medicine, Lucerne, Switzerland; Breast Centre, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Philip Poortmans
- Iridium Netwerk and University of Antwerp, Wilrijk-Antwerpen, Belgium
| | - Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, at Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; GROW-School for Oncology and Reproduction, Maastricht University Medical Centre, Dept. Radiation Oncologv (Maastro), Maastricht, Netherlands
| | - Thorsten Kühn
- Department of Gynecology, Hospital Esslingen, Esslingen, Germany
| | - Michael Gnant
- Austrian Breast and Colorectal Study Group ABCSG, Vienna, Austria; Comprehensive Cancer Center Medical University Vienna, Vienna, Austria
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Heidinger M, Maggi N, Dutilh G, Weber W. P200 Sentinel lymph node biopsy in the elderly breast cancer patient – 10 year experience from a Swiss tertiary center. Breast 2023. [DOI: 10.1016/s0960-9776(23)00318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Weber WP, Matrai Z, Hayoz S, Henke G, Zwahlen DR, Gruber G, Zimmermann F, Ruhstaller T, Muenst S, Ackerknecht M, Kurzeder C, Küemmel S, Bjelic-Radisic V, Smanykó V, Vrieling C, Satler R, Meyer I, Becciolini C, Bucher S, Simonson C, Fehr PM, Gabriel N, Maráz R, Sarlos D, Dedes KJ, Leo C, Berclaz G, Fansa H, Hager C, Reisenberger K, Sávolt Á, Singer CF, Reitsamer R, Winkler J, Lam GTL, Fehr MK, Naydina T, Kohlik M, Clerc K, Ostapenko V, Fitzal F, Heidinger M, Maggi N, Schulz A, Markellou P, Lelièvre L, Egle D, Heil J, Knauer M, Tausch C. Abstract P2-14-08: Trends in neoadjuvant systemic therapy rates in Europe: Pre-planned substudy of TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-14-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Introduction: Even though randomized controlled trials could not show a significant survival benefit for the use of neoadjuvant systemic therapy (NST), it is increasingly recommended for patients with clinically node-positive breast cancer due to its implications on prognosis, locoregional downstaging and response-driven adjuvant systemic therapy. The aim of this study was to assess the need for international standardization of treatment recommendations by evaluating clinical practice heterogeneity in use of NST for patients with clinically node-positive breast cancer in Europe. Methods: The study was preplanned in the international multicenter phase-III OPBC-03/TAXIS trial (ClinicalTrials.gov Identifier: NCT03513614) after randomization of the first 500 patients with clinically node-positive breast cancer who underwent axillary lymph node dissection (ALND) or axillary radiation (ART) without ALND after tailored axillary surgery (TAS) in the context of extended regional nodal irradiation. Clinically node-positive breast cancer was defined by confirmed nodal disease at the time of initial diagnosis; in case of neoadjuvant therapy, residual nodal disease was mandatory. Investigators were encouraged to enroll all eligible patients consecutively. However, TAXIS is unique inasmuch as its pragmatic design allows both the neoadjuvant and adjuvant setting according to the preferences of the treating physicians and institutions and thus provides an excellent opportunity to study patterns and trends in use of NST in patients with clinically positive nodes in Europe. Results: A total of 500 patients with a median age of 57 years (IQR: 48-69 years) were included at 44 breast centers in 6 European countries from August 2018 to June 2022. Subtype was hormone receptor (HR) positive (+) and human epidermal growth factor receptor 2 (HER2) negative (-) in 393 (80.0%), HR+/HER2+ in 52 (10.6%), HR-/HER2+ in 5 (1.0%) and HR-/HER2- in 34 (6.9%) patients. The rate of patients undergoing NST was 31.4% with a significant upward trend over time during the study period (from 20.0% in 2018 to 38.1% in 2022; p=0.044). The use of NST varied significantly by country (p=< 0.001) and by site (p=0.015). For patients with clinical AJCC tumor stage II and III, the rates of patients undergoing NST in Switzerland were 26.5% (18 of 68) and 35.9% (92 of 256), in Germany 22.2% (2 of 9) and 30.4% (7 of 23), in Austria 50% (7 of 14) and 60% (9 of 15) and in Hungary 0% (0 of 15) and 20.7% (18 of 87), respectively (p=0.019 and 0.004). Large differences by country were found for ER+/HER2- breast cancer, ranging from 13.1% (11 of 84) in Hungary to 47.8% (11 of 23) in Austria (p=0.007). Within Switzerland, which was the country with most included patients (328 of 500) and participating sites (n=25), the rate of patients undergoing NST for ER+/HER2- breast cancer varied considerably by site, ranging from 10% (2 of 20) to 50% (11 of 22). Discussion: This study revealed substantial heterogeneity in clinical practice in Europe, indicating the need for development of and adherence to consistent guidelines to standardize the international use of NST.
Citation Format: Walter P. Weber, Zoltan Matrai, Stefanie Hayoz, Guido Henke, Daniel R. Zwahlen, Günther Gruber, Frank Zimmermann, Thomas Ruhstaller, Simone Muenst, Markus Ackerknecht, Christian Kurzeder, Sherko Küemmel, Vesna Bjelic-Radisic, Viktor Smanykó, Conny Vrieling, Rok Satler, Inna Meyer, Charles Becciolini, Susanne Bucher, Colin Simonson, Peter M. Fehr, Natalie Gabriel, Robert Maráz, Dimitri Sarlos, Konstantin J. Dedes, Cornelia Leo, Gilles Berclaz, Hisham Fansa, Christopher Hager, Klaus Reisenberger, Ákos Sávolt, Christian F. Singer, Roland Reitsamer, Jelena Winkler, Giang Thanh Lam Lam, Mathias K. Fehr, Tatiana Naydina, Magdalena Kohlik, Karine Clerc, Valerijus Ostapenko, Florian Fitzal, Martin Heidinger, Nadia Maggi, Alexandra Schulz, Pagona Markellou, Loïc Lelièvre, Daniel Egle, Jörg Heil, Michael Knauer, Christoph Tausch. Trends in neoadjuvant systemic therapy rates in Europe: Pre-planned substudy of TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-08.
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Affiliation(s)
- Walter P. Weber
- 1Breast Center, University Hospital of Basel, Basel, Basel-Stadt, Switzerland
| | - Zoltan Matrai
- 2Hamad Medical Corporation, General Surgery, Doha, Qatar
| | | | - Guido Henke
- 4Department of Radiation Oncology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland; Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel R. Zwahlen
- 5Department of Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Günther Gruber
- 6Institute of Radiotherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Frank Zimmermann
- 7University Hospital of Basel; Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Thomas Ruhstaller
- 8Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Simone Muenst
- 9Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Markus Ackerknecht
- 10Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Christian Kurzeder
- 11Breast Center, University Hospital of Basel, Basel, Basel-Stadt, Switzerland
| | | | | | - Viktor Smanykó
- 14Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Conny Vrieling
- 15Department of Radiation Oncology, Hirslanden Clinique des Grangettes, Geneva, Switzerland
| | - Rok Satler
- 16Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Inna Meyer
- 17Lindenhof Hospital, Praxis Frauenzentrum, Bern, Switzerland
| | - Charles Becciolini
- 18Breast Center, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Susanne Bucher
- 19Breast Center, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Colin Simonson
- 20Department of Gynecology, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Switzerland
| | - Peter M. Fehr
- 21Breast Center Graubünden, Cantonal Hospital Graubünden, Chur, Switzerland
| | | | - Robert Maráz
- 23Department of Oncology, Bacs-Kiskun Country Hospital, Kecskemet, Hungary
| | - Dimitri Sarlos
- 24Breast Center, Cantonal Hospital Aarau, Aarau, Switzerland
| | | | - Cornelia Leo
- 26Breast Center, Cantonal Hospital Baden, Baden, Switzerland
| | - Gilles Berclaz
- 27Breast Center Bern, Lindenhof Group, Bern, Switzerland
| | - Hisham Fansa
- 28Breast Center Zürich, Bethanien & Spital Zollikerberg, Zurich, Switzerland
| | - Christopher Hager
- 29Department of Gynecology and Obstetrics, City Hospital, Dornbirn, Austria
| | - Klaus Reisenberger
- 30Department of Gynecology and Obstetrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Ákos Sávolt
- 31Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Christian F. Singer
- 32Department of Gynecology and Obstetrics and Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Roland Reitsamer
- 33Breast Center, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Jelena Winkler
- 34Breast Center, Bethesda Hospital Basel, Basel, Switzerland
| | | | | | | | - Magdalena Kohlik
- 38Breast Center GSMN, clinique de Genolier, Genolier, Switzerland
| | - Karine Clerc
- 39Brustzentrum Freiburg, Centre du sein Fribourg, Fribourg, Switzerland
| | | | - Florian Fitzal
- 41Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Heidinger
- 42Breast Center, University Hospital of Basel, Basel, Switzerland
| | - Nadia Maggi
- 43Breast Center, University Hospital of Basel, Basel, Switzerland
| | | | - Pagona Markellou
- 45Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | | | - Daniel Egle
- 47Breast Cancer Center Tirol, Department of Gynecology, Medical University Innsbruck, Austria
| | - Jörg Heil
- 48Department of Gynecology and Obstetrics, Breast Unit, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Knauer
- 49Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
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Montagna G, Mrdutt M, Botty A, Barrio AV, Sevilimedu V, Boughey JC, Hoskin TL, Rosenberger LH, Hwang ES, Ingham A, Papassotiropoulos B, Nguyen-Sträuli BD, Kurzeder C, Aybar DD, Vorburger D, Matlac DM, Ostapenko E, Riedel F, Fitzal F, Meani F, Fick F, Sagasser J, Heil J, Dedes KJ, Romics L, Banys-Paluchowski M, Perez MDRC, Diaz MC, Heidinger M, Fehr MK, Reinisch M, Maggi N, Rocco N, Ditsch N, Gentilini OD, Paulinelli RR, Zarhi SS, Küemmel S, Bruzas S, Lascio SD, Parissenti T, Güth U, Ovalle V, Tausch C, Morrow M, Kühn T, Weber WP. Abstract GS4-02: Oncological Outcomes Following Omission of Axillary Lymph Node Dissection in Node Positive Patients Downstaging To Node Negative with Neoadjuvant Chemotherapy: the OPBC-04/EUBREAST-06/OMA study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-gs4-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Data on the oncologic safety of omission of axillary lymph node dissection (ALND) in node positive (N+) patients who downstage to ypN0 with neoadjuvant chemotherapy (NAC) is sparse. Additionally, there is no consensus on which axillary staging procedure should be used in this setting, sentinel lymph node biopsy (SLNB) alone or in combination with localization and retrieval of the clipped positive node, also known as targeted axillary dissection (TAD). Whether the reduction in the false negative rate observed with TAD translates into a significant reduction in the rate of axillary recurrence is unknown. We sought to evaluate oncologic outcomes after omission of ALND in a large, real-world cohort of breast cancer (BC) patients and to compare rates of axillary recurrence after SLNB with dual tracer mapping vs. TAD.
Methods: Data were collected from 19 centers in the Oncoplastic Breast Consortium (OPBC) and EUBREAST networks. Patients with T1-4 biopsy-proven N1-3 BC who underwent NAC followed by axillary staging with either SLNB with dual tracer mapping or TAD and who were pathologically node negative (ypN0) were included. ypN0 was defined as the absence of any tumor or isolated tumor cells. Competing risk analysis was performed to assess the cumulative incidence rates of axillary recurrence, locoregional recurrence, and any invasive (locoregional or distant) recurrence. Two-year cumulative incidence rates were compared between TAD and SLNB using the Gray’s test. Type I error rate was set to 0.05 (α).
Results: We included 785 patients (565 treated with SLNB and 220 with TAD) treated with NAC followed by surgery from 01/2014-12/2020. Median patient age was 50 years. The majority (57%) of patients had clinical T2 tumors, and 95% had N1 disease. Most (55%) were HER2+, and 21% were triple negative. Most patients (81%) received anthracycline and taxane-based chemotherapy regimens, but NAC regimens differed between patients treated with TAD and those treated with SLNB (Table 1). All patients with HER2+ tumors received anti HER2 therapy. Nodal radiotherapy was administered to 76% of patients, and was more common in patients who underwent TAD (82% TAD vs 74% SLNB, p=0.017). Breast pathologic complete response (ypT0/is) was more frequent among those patients that had TAD (80% TAD vs. 66% SLNB, p< 0.001). TAD localization was with wire in 46%, radioactive seed in 40%, ultrasound in 5%, tattoo in 2%, and with a combination of these techniques in 7%. The clipped node was successfully retrieved in 94% of TAD cases. The median number of lymph nodes removed was lower in the TAD group compared to the SLNB group [3 (IQR 3-5) vs 4 IQR 3-5), p< 0.001], as was the median number of sentinel lymph nodes [3 (IQR 2-4) vs 4 IQR 3-5), p< 0.001] (Table 1). The 5-year rates of any axillary recurrence, locoregional recurrence, and any invasive recurrence in the entire cohort were 1.1% (95%CI 0.39-2.4%), 3.1% (95%CI 1.6-5.3%) and 10% (95%CI 7.6-13%), respectively. The two-year cumulative incidence of axillary recurrence did not differ between patients treated with TAD compared to SLNB (0% vs 0.9%, p=0.19).
Conclusion: Early axillary recurrence after omission of ALND in patients who successfully downstage from N+ to ypN0 with NAC is a rare event following both SLNB or TAD, and was not significantly lower in TAD than SLNB. Although longer follow-up is needed to confirm these findings, the main advantage of TAD seems to be a reduction in the number of lymph nodes removed. Overall, these results support omission of ALND in patients who successfully downstage to node negative disease after NAC.
Table 1: Clinicopathological Features of the Study Cohort, Stratified by Axillary Staging Technique
Citation Format: Giacomo Montagna, Mary Mrdutt, Astrid Botty, Andrea V. Barrio, Varadan Sevilimedu, Judy C. Boughey, Tanya L. Hoskin, Laura H. Rosenberger, E Shelley Hwang, Abigail Ingham, Bärbel Papassotiropoulos, Bich Doan Nguyen-Sträuli, Christian Kurzeder, Danilo Diaz Aybar, Denise Vorburger, Dieter Michael Matlac, Edvin Ostapenko, Fabian Riedel, Florian Fitzal, Francesco Meani, Franziska Fick, Jacqueline Sagasser, Jörg Heil, Konstantin J. Dedes, Laszlo Romics, Maggie Banys-Paluchowski, Maria Del Rosario Cueva Perez, Marcelo Chavez Diaz, Martin Heidinger, Mathias K. Fehr, Mattea Reinisch, Nadia Maggi, Nicola Rocco, Nina Ditsch, Oreste Davide Gentilini, Regis Resende Paulinelli, Sebastian Sole Zarhi, Sherko Küemmel, Simona Bruzas, Simona Di Lascio, Tamara Parissenti, Uwe Güth, Valentina Ovalle, Christoph Tausch, Monica Morrow, Thorsten Kühn, Walter P. Weber. Oncological Outcomes Following Omission of Axillary Lymph Node Dissection in Node Positive Patients Downstaging To Node Negative with Neoadjuvant Chemotherapy: the OPBC-04/EUBREAST-06/OMA study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS4-02.
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Affiliation(s)
- Giacomo Montagna
- 1Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mary Mrdutt
- 2Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Astrid Botty
- 3Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | | | | - Judy C. Boughey
- 6Division of Breast and Melanoma Surgical Oncology, Department of Surgery,Mayo Clinic, Rochester, Minnesota
| | - Tanya L. Hoskin
- 7Department of Surgery, Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Abigail Ingham
- 10University of Glasgow and NHS Greater Glasgow and Clyde,Department of Academic Surgery, Glasgow, UK
| | | | | | - Christian Kurzeder
- 13Breast Center, University Hospital of Basel, Basel, Switzerland, Basel-Stadt, Switzerland
| | | | - Denise Vorburger
- 15Breast Cancer Unit, Comprehensive Cancer Center Zurich, University Hospital Zurich, Zurich,Switzerland
| | - Dieter Michael Matlac
- 16Department of Gynecology and Obstetrics, University of Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Edvin Ostapenko
- 17Department of General Surgery and Breast Health Center, Medical University of Vienna, Vienna, Austria; Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Fabian Riedel
- 18Department of Gynecology and Obstetrics, Breast Unit, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Fitzal
- 19Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesco Meani
- 20Centro di Senologia della Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Franziska Fick
- 21Department of Gynecology and Obstetrics, University of Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Jacqueline Sagasser
- 22Department of Obstetrics and Gynecology, University Hospital of Augsburg, Augsburg, Germany
| | - Jörg Heil
- 23Department of Gynecology and Obstetrics, Breast Unit, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Laszlo Romics
- 25Department of Academic Surgery, Gartnavel General Hospital Glasgow,University of Glasgow, Glasgow, UK
| | - Maggie Banys-Paluchowski
- 26Department of Gynecology and Obstetrics, University of Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | | | | | - Martin Heidinger
- 29Breast Center, University Hospital of Basel, Basel, Switzerland
| | | | - Mattea Reinisch
- 31Interdisciplinary Breast Cancer Center/Breast Unit, Essen, Germany
| | - Nadia Maggi
- 32Breast Center, University Hospital of Basel, Basel, Switzerland
| | - Nicola Rocco
- 33Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Nina Ditsch
- 34Department of Gynaecology and Obstetrics, University Hospital Augsburg, Augsburg,Germany
| | | | | | - Sebastian Sole Zarhi
- 37Department of Radiation Oncology, University Diego Portales – IRAM, Santiago, Chile
| | | | | | - Simona Di Lascio
- 40Service of medical oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | | | - Uwe Güth
- 42Breast Center Zurich, Zurich, Switzerland; University of Basel, Basel, Switzerland
| | - Valentina Ovalle
- 43Department of Radiation Oncology, University Diego Portales – IRAM, Santiago, Chile
| | | | | | - Thorsten Kühn
- 46Department of Gynecology, Hospital Esslingen, Esslingen, Germany
| | - Walter P. Weber
- 47Breast Center, University Hospital of Basel, Basel, Switzerland, Basel-Stadt, Basel-Stadt, Switzerland
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Nussbaumer RL, Maggi N, Castrezana L, Zehnpfennig L, Schwab FD, Krol J, Oberhauser I, Weber WP, Kurzeder C, Haug MD, Kappos EA. The impact of neoadjuvant systemic treatment on postoperative complications in breast cancer surgery. Breast Cancer Res Treat 2023; 197:333-341. [PMID: 36403182 PMCID: PMC9823081 DOI: 10.1007/s10549-022-06811-0] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of the study was to analyze the impact of neoadjuvant systemic treatment (NST) on postoperative complications and the beginning of adjuvant treatment. METHODS This study includes data from a prospectively maintained database including patients with breast cancer (BC) stage I-IV with or without NST undergoing breast cancer surgery between January 2010 and September 2021. RESULTS Out of 517 enrolled patients, 77 received NST, 440 had primary breast surgery. After NST patients underwent surgery after a meantime of 34 days (26.5-40 days). No statistical significance could be found comparing the complication grading according to the Clavien Dindo classification. The complications were most frequently rated as grade 3b. There were no complications with grade 4 or higher. When differentiating into short and long-term, the overall rate of short-term complications was 20.3% with no significant difference between the two groups (20.8% vs. 20.2%). Regarding long-term complications, there was more impairment of shoulder mobility (26.0% vs. 9.5%, p ≤ 0.001) and chronic pain (42.9% vs. 28.6%, p ≤ 0.016) for patients with NST. The beginning of the administration of the adjuvant treatment was comparable in both groups (46.3 days vs. 50.5 days). CONCLUSION In our cohort, complications between both groups were comparable according to Clavien Dindo. This study shows that NST has no negative impact on postoperative short-term complications and most importantly did not lead to a delay of the beginning of adjuvant treatment. Therefore, NST can be safely admitted, even when followed by extensive breast reconstruction surgery.
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Affiliation(s)
- R. L. Nussbaumer
- grid.410567.1Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland ,grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - N. Maggi
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - L. Castrezana
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - L. Zehnpfennig
- grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - F. D. Schwab
- grid.410567.1Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland ,grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - J. Krol
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - I. Oberhauser
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - W. P. Weber
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - C. Kurzeder
- grid.410567.1Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland ,grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - M. D. Haug
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland ,grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Elisabeth A. Kappos
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland ,grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
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10
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Zehnpfennig L, Ritter M, Montagna G, Handschin TM, Ling BM, Oberhauser I, Lévy J, Schaefer KM, Maggi N, Soysal SD, López LC, Müller MM, Schwab FD, Haug M, Weber WP, Kurzeder C, Kappos EA. The Impact of Delayed Wound Healing on Patient-Reported Outcomes After Breast Cancer Surgery. J Plast Reconstr Aesthet Surg 2022; 75:4125-4132. [DOI: 10.1016/j.bjps.2022.06.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 04/14/2022] [Accepted: 06/07/2022] [Indexed: 10/31/2022]
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11
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Fedier A, Maggi N, Tozzi A, Disler M, Coelho R, Jacob F, Heinzelmann-Schwarz V. Exposure to escalating olaparib does not induce acquired resistance to PARPi and to other chemotherapeutic compounds in ovarian cancer cell lines. Int J Oncol 2022; 61:89. [PMID: 35642662 PMCID: PMC9170353 DOI: 10.3892/ijo.2022.5379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 05/13/2022] [Indexed: 11/06/2022] Open
Abstract
Poly (ADP-ribose) polymerase (PARP)-inhibitors (PARPi) such as olaparib and niraparib are currently used as a treatment option for BRCA-deficient tumors and also show efficacy in platinum-sensitive tumors. However, resistance to PARPi occurs in numerous patients and in particular acquired PARPi resistance presents a major obstacle in the treatment of these tumors. In the present study, it was investigated whether stepwise exposure of ovarian cancer cells to escalating concentrations of olaparib produced subcells with acquired resistance to PARPi and/or acquired cross-resistance to platinum compounds, paclitaxel, and doxorubicin. To this aim, the sensitivity of fourteen ovarian cancer cell lines, including nine with TP53-mutations and five carrying BRCA-mutations, to olaparib and niraparib was determined and a subset of seven cell lines was selected to investigate the potential of olaparib to produce resistance. It was identified that escalating olaparib did neither produce subcells with acquired PARPi-resistance nor did it produce acquired cross-resistance to platinum compounds, doxorubicin, and paclitaxel. This finding was independent of the cells' TP53 and BRCA mutation status. CRISPR-Cas9 mediated deletion of PARP1 did not affect sensitivity to PARPi, platinum compounds, doxorubicin, and paclitaxel. In addition, olaparib sensitivity correlated with niraparib sensitivity, but BRCA-mutated cells were not more sensitive to PARPi. Moreover, PARPi sensitivity associated with cross-sensitivity not only to platinum compounds but also to anthracylines, paclitaxel, and inhibitors of histone deacetylases. These in vitro data indicated that olaparib exposure is unlikely to produce an acquired resistance phenotype and that PARPi-sensitive ovarian cancer cells are also cross-sensitive to non-platinum and even to compounds not directly interacting with the DNA.
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Affiliation(s)
- André Fedier
- Ovarian Cancer Research Program, Department of Biomedicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Nadia Maggi
- Ovarian Cancer Research Program, Department of Biomedicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Alessandra Tozzi
- Hospital for Women, Department of Gynecology and Gynecological Oncology, Women's Hospital, University Hospital Basel, University of Basel, 4021 Basel, Switzerland
| | - Muriel Disler
- Ovarian Cancer Research Program, Department of Biomedicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Ricardo Coelho
- Ovarian Cancer Research Program, Department of Biomedicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Francis Jacob
- Ovarian Cancer Research Program, Department of Biomedicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Viola Heinzelmann-Schwarz
- Ovarian Cancer Research Program, Department of Biomedicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
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12
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Weber WP, Shaw J, Pusic A, Wyld L, Morrow M, King T, Mátrai Z, Heil J, Fitzal F, Potter S, Rubio IT, Cardoso MJ, Gentilini OD, Galimberti V, Sacchini V, Rutgers EJT, Benson J, Allweis TM, Haug M, Paulinelli RR, Kovacs T, Harder Y, Gulluoglu BM, Gonzalez E, Faridi A, Elder E, Dubsky P, Blohmer JU, Bjelic-Radisic V, Barry M, Hay SD, Bowles K, French J, Reitsamer R, Koller R, Schrenk P, Kauer-Dorner D, Biazus J, Brenelli F, Letzkus J, Saccilotto R, Joukainen S, Kauhanen S, Karhunen-Enckell U, Hoffmann J, Kneser U, Kühn T, Kontos M, Tampaki EC, Carmon M, Hadar T, Catanuto G, Garcia-Etienne CA, Koppert L, Gouveia PF, Lagergren J, Svensjö T, Maggi N, Kappos EA, Schwab FD, Castrezana L, Steffens D, Krol J, Tausch C, Günthert A, Knauer M, Katapodi MC, Bucher S, Hauser N, Kurzeder C, Mucklow R, Tsoutsou PG, Sezer A, Çakmak GK, Karanlik H, Fairbrother P, Romics L, Montagna G, Urban C, Walker M, Formenti SC, Gruber G, Zimmermann F, Zwahlen DR, Kuemmel S, El-Tamer M, Vrancken Peeters MJ, Kaidar-Person O, Gnant M, Poortmans P, de Boniface J. Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy. Breast 2022; 63:123-139. [PMID: 35366506 PMCID: PMC8976143 DOI: 10.1016/j.breast.2022.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 12/31/2022] Open
Abstract
Aim Demand for nipple- and skin- sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario. Methods A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology. Results The panel agreed that surgical technique for NSM/SSM should not be formally modified when PMRT is planned with preference for autologous over implant-based BR due to lower risk of long-term complications and support for immediate and delayed-immediate reconstructive approaches. Nevertheless, it was strongly believed that PMRT is not an absolute contraindication for implant-based or other types of BR, but no specific recommendations regarding implant positioning, use of mesh or timing were made due to absence of high-quality evidence. The panel endorsed use of patient-reported outcomes in clinical practice. It was acknowledged that the shape and size of reconstructed breasts can hinder radiotherapy planning and attention to details of PMRT techniques is important in determining aesthetic outcomes after immediate BR. Conclusions The panel endorsed the need for prospective, ideally randomised phase III studies and for surgical and radiation oncology teams to work together for determination of optimal sequencing and techniques for PMRT for each patient in the context of BR Autologous breast reconstruction is increasingly preferred over implants in the setting of radiation therapy. Use of patient-reported outcomes is endorsed. Shape and size of reconstructed breasts can hinder radiotherapy planning. There is a need for randomised phase III trials.
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Affiliation(s)
- Walter Paul Weber
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Jane Shaw
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Andrea Pusic
- Brigham and Women's/Dana Farber Cancer Center, USA
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Monica Morrow
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tari King
- Department of Surgery, Brigham and Women's Hospital / Dana Farber Cancer Institute, USA
| | - Zoltán Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Jörg Heil
- Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Shelley Potter
- Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Clifton, Bristol, UK
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Maria-Joao Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, And Nova Medical School, Lisbon, Portugal
| | | | | | - Virgilio Sacchini
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emiel J T Rutgers
- Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - John Benson
- Cambridge Breast Unit, Addenbrooke's Hospital Cambridge, Cambridge, UK; Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation TRUST, School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Tanir M Allweis
- Hadassah Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Martin Haug
- Breast Center and Department of Plastic, Reconstructive, Aesthetic and Handsurgery University Hospital Basel, University of Basel, Basel, Switzerland
| | - Regis R Paulinelli
- Federal University of Goiás, Araújo Jorge Hospital, Goiás Anti-Cancer Association, Goiás, Brazil
| | - Tibor Kovacs
- Jiahui Internatioonal Hospital Shanghai, China; Guy's and St. Thomas' NHS Foundation Trust London, UK
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | | | - Eduardo Gonzalez
- Departament of Mastology, Breast Unit- Instituto de Oncología Angel H Roffo, Buenos Aires Univesity. Buenos Aires, Argentina
| | - Andree Faridi
- Department of Senology/Breast Center, University Hospital Bonn, Germany
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Australia
| | - Peter Dubsky
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Breast Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Jens-Uwe Blohmer
- Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Hospital, University Witten/Herdecke, Wuppertal, Germany
| | - Mitchel Barry
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Susanne Dieroff Hay
- Patient Advocacy Group, Oncoplastic Breast Consortium, President, the Swedish Breast Cancer Association, Stockholm, Sweden
| | - Kimberly Bowles
- Patient Advocacy Group, Oncoplastic Breast Consortium, Not Putting on A Shirt, Pittsburgh, USA
| | - James French
- Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Australia
| | - Roland Reitsamer
- Breast Center Salzburg, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Rupert Koller
- Department of Plastic, Aesthetic and Reconstructive Surgery, Vienna Health Services, Clinic Landstrasse and Clinic Ottakring, Vienna, Austria
| | - Peter Schrenk
- Breast Cancer Center, Kepler University Hospital, Linz, Austria
| | | | - Jorge Biazus
- Division of Breast Surgery, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Fabricio Brenelli
- Breast Oncology Division, University of Campinas, Campinas, São Paulo, Brazil
| | - Jaime Letzkus
- San Borja Arriaran Clinical Hospital, University of Chile, Chile
| | | | | | - Susanna Kauhanen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ulla Karhunen-Enckell
- Tampere University Hospital, Department of Surgery and Tays Cancer Center, Tampere, Finland
| | - Juergen Hoffmann
- Breast Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery - Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany
| | - Thorsten Kühn
- Interdisciplinary Breast Center, Klinikum Esslingen, Germany
| | | | - Ekaterini Christina Tampaki
- Department of Plastic, Reconstructive Surgeryand Burn Unit, KAT Athens Hospital and Trauma Center, Athens, Greece
| | | | - Tal Hadar
- Hadassah Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Giuseppe Catanuto
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | | | - Linetta Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Pedro F Gouveia
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, And Nova Medical School, Lisbon, Portugal
| | - Jakob Lagergren
- Department of Surgery, Capio St Goran's Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Tor Svensjö
- Department of Surgery, Central Hospital, Kristianstad, Sweden
| | - Nadia Maggi
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Elisabeth A Kappos
- Breast Center and Department of Plastic, Reconstructive, Aesthetic and Handsurgery University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Daniel Steffens
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Janna Krol
- Breast Center, University Hospital Basel, Basel, Switzerland
| | | | | | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Maria C Katapodi
- University of Basel, Basel, Switzerland; Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Susanne Bucher
- Breast Center, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Nik Hauser
- Breast Center, Hirslanden Clinic Aarau, Aarau, Frauenarztzentrum Aargau AG, Baden, Switzerland
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Rosine Mucklow
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Pelagia G Tsoutsou
- University Hospital Geneva, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Atakan Sezer
- Department of Surgery, Trakya University Medical School Hospital, Turkey
| | - Güldeniz Karadeniz Çakmak
- Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | | | - Patricia Fairbrother
- Patient Advocacy Group, Oncoplastic Breast Consortium, Breakthrough Breast Cancer, Association Breast Surgery UKBCC, Kedleston, UK
| | - Laszlo Romics
- Department of Surgery, New Victoria Hospital, Glasgow, UK
| | - Giacomo Montagna
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cicero Urban
- Breast Unit, Hospital Nossa Senhora Das Graças, Curitiba, Brazil
| | - Melanie Walker
- Breast Endocrine and General Surgery Unit, The Alfred, Melbourne, Australia; Breast Surgeons of Australia and New Zealand (BreastSurgANZ), Australia
| | - Silvia C Formenti
- Department of Radiation Oncology and Meyer Cancer Center, Weill Cornell Medicine, USA
| | - Guenther Gruber
- Institute for Radiotherapy, Klinik Hirslanden, 8032, Zurich, Switzerland; University of Berne, 3000, Bern, Switzerland
| | - Frank Zimmermann
- Clinic of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Daniel Rudolf Zwahlen
- Department of Radiation Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Sherko Kuemmel
- Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany; Breast Unit, Kliniken Essen-Mitte, Germany
| | - Mahmoud El-Tamer
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marie Jeanne Vrancken Peeters
- Department of Surgical Oncology Netherlands Cancer Institute, Antoni van Leeuwenhoek & Amsterdam University Medical Center, Netherlands
| | - Orit Kaidar-Person
- Breast Radiation Therapy Unit, Sheba Tel Hashomer, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Philip Poortmans
- Iridium Netwerk and University of Antwerp, Wilrijk-Antwerpen, Belgium
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden
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13
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Weber WP, Matrai Z, Hayoz S, Tausch C, Henke G, Zwahlen DR, Gruber G, Zimmermann F, Seiler S, Maddox C, Ruhstaller T, Muenst S, Ackerknecht M, Kuemmel S, Bjelic-Radisic V, Kurzeder C, Újhelyi M, Vrieling C, Satler R, Meyer I, Becciolini C, Bucher S, Simonson C, Fehr PM, Gabriel N, Maráz R, Sarlos D, Dedes KJ, Leo C, Berclaz G, Dubsky P, Exner R, Fansa H, Hager C, Reisenberger K, Singer CF, Reitsamer R, Reinisch M, Winkler J, Lam GT, Fehr MK, Naydina T, Kohlik M, Clerc K, Ostapenko V, Fitzal F, Nussbaumer R, Maggi N, Schulz A, Markellou P, Lelièvre L, Egle D, Heil J, Knauer M. 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. [PMID: 34555676 PMCID: PMC8463904 DOI: 10.1016/j.breast.2021.09.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/24/2022] Open
Abstract
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. Tailored axillary surgery is a novel concept for clinically node-positive breast cancer Tailored axillary surgery selectively removes positive lymph nodes Tailored axillary surgery is much less radical than axillary dissection Tailored axillary surgery removes the clipped node in the vast majority of patients
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Affiliation(s)
- Walter P Weber
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Zoltan Matrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary; University of Szeged, H-6725 Szeged, Hungary
| | | | | | - Guido Henke
- Department of Radiation Oncology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland; Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Günther Gruber
- Institute of Radiotherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Frank Zimmermann
- University of Basel, Basel, Switzerland; Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | | | | | | | - Simone Muenst
- University of Basel, Basel, Switzerland; Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Markus Ackerknecht
- University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | | | | | - Christian Kurzeder
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Mihály Újhelyi
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Conny Vrieling
- Department of Radiation Oncology, Hirslanden Clinique des Grangettes, Geneva, Switzerland
| | - Rok Satler
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Inna Meyer
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Charles Becciolini
- Breast Center, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Susanne Bucher
- Breast Center, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Colin Simonson
- Department of Gynecology, Centre Hospitalier du Haut-Valais (SZO), Sion, Switzerland
| | - Peter M Fehr
- Breast Center Graubünden, Cantonal Hospital Graubünden, Chur, Switzerland
| | | | - Robert Maráz
- Department of Oncology, Bacs-Kiskun Country Hospital, Kecskemet, Hungary
| | - Dimitri Sarlos
- Breast Center, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Konstantin J Dedes
- Breast Cancer Center, University Hospital of Zurich, Zurich, Switzerland
| | - Cornelia Leo
- Breast Center, Cantonal Hospital Baden, Baden, Switzerland
| | | | - Peter Dubsky
- Breast Center, Hirslanden Klinik St. Anna, Lucerne, Switzerland; Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hisham Fansa
- Breast Center Zürich, Bethanien & Spital Zollikerberg, Zurich, Switzerland
| | - Christopher Hager
- Department of Gynecology and Obstetrics, City Hospital, Dornbirn, Austria
| | - Klaus Reisenberger
- Department of Gynecology and Obstetrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Christian F Singer
- Department of Gynecology and Obstetrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Roland Reitsamer
- Breast Center, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | | - Jelena Winkler
- Breast Center, Basel Bethesda Hospital, Basel, Switzerland
| | - Giang Thanh Lam
- Breast Center, University Hospital of Geneva, Geneva, Switzerland
| | | | | | | | - Karine Clerc
- Brustzentrum Freiburg, Centre du sein Fribourg, Fribourg, Switzerland
| | | | - Florian Fitzal
- Department of Surgery and Breast Health Center, Medical University of Vienna, Vienna, Austria
| | - Rahel Nussbaumer
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Nadia Maggi
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Alexandra Schulz
- University of Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Pagona Markellou
- Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | | | - Daniel Egle
- Breast Cancer Center Tirol, Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Jörg Heil
- Breast Center Heidelberg, Heidelberg, Germany
| | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
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14
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Abstract
Long-term follow-up data from multicenter phase III non-inferiority trials confirmed the safety of omission of axillary dissection in selected patients with clinically node-negative, sentinel node-positive breast cancer. Several ongoing trials investigate extended eligibility of the Z0011 protocol in the adjuvant setting. De-escalation of axillary surgery in patients with clinically node-positive breast cancer is currently limited to the neoadjuvant setting, where the sentinel procedure is used to determine nodal pathological complete response. Targeted axillary dissection lowers the false-negative rate of the sentinel procedure, which, however, is consistently associated with a very low risk of axillary recurrence in several recent single-center series. Axillary dissection remains standard care in patients with residual disease after neoadjuvant chemotherapy while the results of Alliance A011202 are pending. The TAXIS trial investigates the role of tailored axillary surgery in patients with clinically node-positive breast cancer, a novel concept designed to selectively remove positive nodes in the adjuvant and neoadjuvant setting.
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Affiliation(s)
- Nadia Maggi
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Rahel Nussbaumer
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Liezl Holzer
- Department of Gynecology, University Hospital Zurich, Zurich, Switzerland
| | - Walter P Weber
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
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15
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Nguyen BD, Vorburger D, Frauchiger-Heuer H, Bringolf L, Maggi N, Talimi-Schnabel J, Dedes K. Abstract PS1-64: Prepectoral implant-based breast reconstruction with TiLOOP-bra pocket - a single-center retrospective study. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps1-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aim: To evaluate the perioperative outcome and cosmetic outcome of prepectoral implant-based breast reconstruction using the TiLOOP® Bra Pocket.Background: Besides acellular dermal matrix (ADM), synthetic meshes have revealed good surgical and aesthetic outcomes. We present our data using TiLOOP® Bra Pocket, a ready-to-use mesh pocket which is made out of nonresorbable, titanized, lightweight polypropylene with a monofilament structure and designed to ensure optimal fixation of the breast implant following mastectomy. The idea behind the mesh pocket is to fix the implant to the muscle and provide coverage and stabilization for the implant by serving as an ´internal bra´, which will create an inferior and lateral sling to support the position and stability of the implant and prevent it from dislocating or twisting.
Materials and Methods: A single-center retrospective study was performed to assess short-term complication rates and cosmetic outcomes in patients with immediate or delayed implant-based breast reconstruction using the TiLOOP® Bra Pocket after nipple- or skin-sparing mastectomy. The primary endpoint was complication rates, which were divided into major and minor complications during the first 6 months. Minor complications were defined as those treated conservatively, major complications were those requiring surgical therapy. The secondary endpoint was short-term cosmetic outcome after 6 to 12 months, which was judged by two professionals using the Harvard score (1 = poor, 2 = fair, 3 = good, 4 = excellent).
Results: A total of 63 breasts (43 patients) were reconstructed by implant using the TiLOOP® Bra Pocket between 2018 and 2020, of which 57 were immediate reconstructions. Mean follow-up was 12 months. The overall complication rate was 30,2 % (n = 19/63). Major complications occured in 7 breasts (n = 7/63; 11,1 %) and minor complications occured in 12 breasts (12/63; 19,0 %). The cosmetic outcome was good (Harvard score: mean 3, range 1-4; SD 0,75). Seventeen cosmetic complications were observed (17/63; 27,0 %) and 6 cosmetic revision surgeries were performed (6/63; 9,5 %).
Conclusion: Immediate prepectoral implant-based breast reconstruction with the TiLOOP® Bra Pocket seems to be a feasible method with moderate complication rates and good cosmetic outcomes. Careful patient selection and preparation techniques considering flap viability are vital in order to achieve acceptable complication rates and satisfying cosmetic results. Long-term follow-up is needed. The next follow-up will be performed after 24 months.
Perioperative OutcomeComplications22Seroma with punction7/63 (11,1%)Seroma without punction1/63 (1,6 %)Hemorrhage2/63 (3,2 %)Nipple necrosis2/63 (3,2 %)Implant Infection3/63 (4,8 %)Skin Infection3/63 (4,8 %)Wound healing deficiency2/63 (3,2 %)Implant loss2/63 (3,2 %)Unplanned resurgery < 3 mo8 (12,7 %)
Cosmetic Complication (N=17)Rippling2 (3,2 %)Asymmetry4 (6,3 %)Capsule contracture3 (4,8 %)Fat defects3 (4,8 %)Rotation2 (3,2 %)Cranialisation3 (4,8 %)
Cosmetic Outcome (Harvard score; 1 = poor, 2 = fair, 3 = good, 4 = excellent)Observer 13,0 (1 - 4), SD 0,8Observer 23,4 (1-4), SD 0,7
Citation Format: Bich Doan Nguyen, Denise Vorburger, Heike Frauchiger-Heuer, Lilian Bringolf, Nadia Maggi, Julia Talimi-Schnabel, Konstantin Dedes. Prepectoral implant-based breast reconstruction with TiLOOP-bra pocket - a single-center retrospective study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-64.
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Affiliation(s)
| | | | | | | | - Nadia Maggi
- University Hospital Zurich, Zurich, Switzerland
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Esposito C, Villa L, Grosjean F, Mangione F, Esposito V, Castoldi F, Serpieri N, Arra M, Pertile E, Maggi N, Valentino R, Dal Canton A. Rapamycin reduces proteinuria and renal damage in the rat remnant kidney model. Transplant Proc 2014; 41:1370-1. [PMID: 19460562 DOI: 10.1016/j.transproceed.2009.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rapamycin is an immunosuppressive drug used to prevent acute allograft rejection in solid organ transplantation. It shows less nephrotoxicity than calcineurin inhibitors. We evaluated the effect of rapamycin in rats undergoing 5/6 nephrectomy, a model of proteinuric and progressive renal failure. Fourteen days after surgery rats were randomized either to receive rapamycin or to remain untreated (control). Rats were humanely killed on day 91; serum creatinine, creatinine clearance, and proteinuria were assessed. Renal sections were stained with periodic acid-Schiff to evaluate glomerular volume (Gv), glomerulosclerosis (GS) and tubulointerstitial damage (TIS); we evaluated GS and TIS by Sirius red staining (SR). Epithelial-to-mesenchymal transition (EMT) was assessed by immunohistochemistry. Rapamycin affected neither serum creatinine nor creatinine clearance; it reduced Gv (controls, 5.9 +/- 3.1 x 10(6); rapamycin, 1.3 +/- 0.7 x 10(6) microm(3)) and proteinuria (control, 349 +/- 146; rapamycin, 56 +/- 27 mg/24 h; P < .05); rapamycin ameliorated GS (control, 78 +/- 7; rapamycin, 36 +/- 7%; P < .05; SR: control, 13.2 +/- 3.5; rapamycin, 3.8 +/- 1.0%; P < .05), and TIS (control, 3.25 +/- 0.5; rapamycin, 1.0 +/- 0.1; P < .05; SR: control, 29 +/- 3; rapamycin, 11 +/- 3%; P < .05). Rapamycin reduced alphaSMA (control, 3.25 +/- 0.5; rapamycin, 1.0 +/- 0.1; P < .05), VIM (control, 3.5 +/- 0.6; rapamycin, 1.0 +/- 1.4; P < .05), and CD68(+) cells infiltration (control, 110 +/- 43; rapamycin, 24 +/- 1 cells; P < .05). Rapamycin slows the progression of renal damage in the rat remnant kidney and may represent a novel approach to the treatment of chronic kidney disease.
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Affiliation(s)
- C Esposito
- Unit of Nephrology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
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Berthelot L, Robert T, Tabary T, Vuiblet V, Drame M, Toupance O, Rieu P, Monteiro RC, Toure F, Ferrario S, Cantaluppi V, De Lena M, Dellepiane S, Beltramo S, Rossetti M, Manzione AM, Messina M, Gai M, Dolla C, Biancone L, Camussi G, Pontrelli P, Oranger AR, Accetturo M, Rascio F, Gigante M, Castellano G, Schena A, Fiorentino M, Zito A, Zaza G, Stallone G, Gesualdo L, Grandaliano G, Pattonieri EF, Gregorini M, Corradetti V, Rocca C, Milanesi S, Peloso A, Ferrario J, Cannone M, Bosio F, Maggi N, Avanzini MA, Minutillo P, Paulli M, Maestri M, Rampino T, Dal Canton A, Wu KST, Coxall O, Luque Y, Candon S, Rabant M, Noel LH, Thervet E, Chatenoud L, Snanoudj R, Anglicheau D, Legendre C, Zuber J, Hruba P, Brabcova I, Krepsova E, Slatinska J, Sekerkova A, Striz I, Zachoval R, Viklicky O, Scholbach TM, Wang HK, Loong CC, Yang AH, Wu TH, Hruba P, Brabcova I, Krepsova E, Slatinska J, Sekerkova A, Striz I, Zachoval R, Viklicky O, Guberina H, Rebmann V, Dziallas P, Dolff S, Wohlschlaeger J, Heinemann FM, Witzke O, Zoet YM, Claas FHJ, Horn PA, Kribben A, Doxiadis IIN, Prasad N, Yadav B, Agarwal V, Jaiswal A, Rai M, Hope CM, Coates PT, Heeger PS, Carroll R, Zaza G, Masola V, Secchi MF, Onisto M, Gambaro G, Lupo A, Matsuyama M, Kobayashi T, Yoneda Y, Chargui J, Touraine JL, Yoshimura R, Vizza D, Perri A, Lupinacci S, Toteda G, Lofaro D, Leone F, Gigliotti P, La Russa A, Papalia T, Bonofilgio R, Sentis Fuster A, Kers J, Yapici U, Claessen N, Bemelman FJ, Ten Berge IJM, Florquin S, Glotz D, Rostaing L, Squifflet JP, Merville P, Belmokhtar C, Le Ny G, Lebranchu Y, Papazova DA, Friederich-Persson M, Koeners MP, Joles JA, Verhaar MC, Trivedi HL, Vanikar AV, Dave SD, Suarez Alvarez B, Garcia Melendreras S, Carvajal Palao R, Diaz Corte C, Ruiz Ortega M, Lopez-Larrea C, Yadav AK, Bansal D, Kumar V, Kumar V, Minz M, Jha V, Kaminska D, Koscielska-Kasprzak K, Chudoba P, Mazanowska O, Banasik M, Zabinska M, Boratynska M, Lepiesza A, Korta K, Klinger M, Csohany R, Prokai A, Pap D, Balicza-Himer N, Vannay A, Fekete A, Kis-Petik K, Peti-Peterdi J, Szabo A, Masajtis-Zagajewska A, Muras K, Niewodniczy M, Nowicki M, Pascual J, Srinivas TR, Chadban S, Citterio F, Henry M, Legendre C, Oppenheimer F, Lee PC, Tedesco-Silva H, Zeier M, Watarai Y, Dong G, Hexham M, Bernhardt P, Vincenti F, Rocchetti MT, Pontrelli P, Rascio F, Fiorentino M, Zito A, Stallone G, Gesualdo L, Grandaliano G, Su owicz J, Wojas-Pelc A, Ignacak E, Janda K, Krzanowski M, Su owicz W, Dellepiane S, Cantaluppi V, Mitsuhashi M, Murakami T, Benso A, Biancone L, Camussi G, Scholbach TM, Wang HK, Loong CC, Wu TH, Leuning D, Reinders M, Lievers E, Duijs J, Van Zonneveld AJ, Van Kooten C, Engelse M, Rabelink T, Assounga A, Omarjee S, Ngema Z, Ersoy A, Gultepe A, Isiktas Sayilar E, Akalin H, Coskun F, Oner Torlak M, Ayar Y, Riegersperger M, Plischke M, Steinhauser C, Jallitsch-Halper A, Sengoelge G, Winkelmayer WC, Sunder-Plassmann G, Foedinger M, Kaziuk M, Kuz'Niewski M, Ignacak E, B Tkowska- Prokop A, Pa Ka K, Dumnicka P, Kolber W, Su Owicz W. TRANSPLANTATION BASIC SCIENCE, ALLOGENIC AND XENOGENIC TOLERANCE. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kozakowski N, Herkner H, Bohmig GA, Kikic Z, Cooper DJ, Eller K, Kirsch AH, Lane PJ, Neirynck N, Glorieux G, Schepers E, Dhondt A, Vanholder R, Corradetti V, Milanesi S, Rocca C, Avanzini MA, Pattonieri EF, Bosio F, Cannone M, Maggi N, Gregorini M, Esposito P, Rampino T, Dal Canton A, Roelofs JJ, Redecha P, Salmon JE, Rho E, Artinger K, Kirsch AH, Schaubettl C, Aringer I, Rosenkranz AR, Eller P, Eller K, Perri A, Vizza D, Toteda G, Lupinacci S, Lofaro D, Leone F, Gigliotti P, La Russa A, Papalia T, Bonofilgio R, Artinger K, Kirsch AH, Rho E, Schabhuttl C, Eller P, Rosenkranz AR, Eller K. PATHOLOGY: IMMUNE AND INFLAMMATORY MECHANISMS. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vethe H, Finne K, Skogstrand T, Vaudel M, Vikse BE, Hultstrom M, Placier S, Scherer A, Tenstad O, Marti HPP, Milanesi S, Rocca C, Gregorini M, Corradetti V, Pattonieri EF, Cannone M, Maggi N, Bosio F, Esposito P, Bianco C, Benzoni I, Maestri M, Avanzini MA, Rampino T, Dal Canton A, Kadoya H, Satoh M, Sasaki T, Kashihara N, Pongsakul N, Thongboonkerd V, Hsu HH, Chen KH, Tian YC, Chen YC, Hung CC, Yang CW, Yamamoto Y, Iyoda M, Wada Y, Suzuki T, Matsumoto K, Shindo-Hirai Y, Kuno Y, Saito T, Iseri K, Shibata T, Da Silva AF, Teixeira VC, Schor N, Paterno J, Naves MA, Visiona I, Schor N, Teixeira VP, Borda B, Lengyel C, Varkonyi T, Ivanyi B, Keresztes C, Lazar G, Edamatsu T, Fujieda A, Ezawa A, Itoh Y, Detsika MG, Duann P, Carvalho FF, Teixeira VP, Almeida WS, Schor N, Wagner S, Schnorr J, Glaser J, Gemeinhardt I, Ebert M, Klopfleisch R, Taupitz M, Frangou EA, Rizou M, Prakoura N, Zoidakis J, Vlahou A, Gakiopoulou H, Liapis G, Charonis A, Kayukov I, Parastaeva M, Beresneva O, Ivanova G, Kucher A, Karunnaya H, Zarayski M, Smirnov A, Chandak PG, Smirnov A, Sipovski V, Beresneva O, Parastaeva M, Ivanova G, Kucher A, Sipovski E, Zarayski M, Karunnaya H, Dobronravov V, Kayukov I, Masola V, Zaza G, Granata S, Secchi MF, Onisto M, Lupo A, Gambaro G, Kim JI, Jang HS, Han SJ, Park KM, Grchevska L, Paterno JC, Ramos MDFP, Razvickas CV, Rehder VL, Schor N, Teixeira VP, Raya AI, Pineda CM, Guerrero F, Rios R, Aguilera E, Peralta A, Lopez I, Parastaeva M, Beresneva O, Kucher A, Ivanova G, Kayukov I, Smirnov A, Takenaka T, Inoue T, Miyazaki T, Hayashi M, Suzuki H, Garrido P, Fernandes J, Ribeiro S, Vala H, Belo L, Costa E, Santos-Silva A, Reis F, Shi Y, Tsuboi N, Maruyama S, Matsuo S, Piecha D, Koch S, Steppan S, Loser K. EXPERIMENTAL PATHOLOGY. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Esposito C, Migotto C, Torreggiani M, Maggi N, Manini A, Castoldi F, Grosjean F, Mangione F, Abelli M, Scaramuzzi M, Catucci D, Dal Canton A. Pretransplant and Protocol Biopsies May Help in Defining Short and Mid-term Kidney Transplant Outcome. Transplant Proc 2012; 44:1889-91. [DOI: 10.1016/j.transproceed.2012.07.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Esposito C, Abelli M, Sileno G, Migotto C, Torreggiani M, Serpieri N, Maggi N, Esposito V, Grosjean F, Scaramuzzi M, Montagna F, Canton A. Effects of Continuous Erythropoietin Receptor Activator (CERA) in Kidney Transplant Recipients. Transplant Proc 2012; 44:1916-7. [DOI: 10.1016/j.transproceed.2012.05.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Esposito C, Valentino R, Villa L, Serpieri N, Mangione F, Grosjean F, Esposito V, Castoldi F, Sileno G, Montagna F, Maggi N, Torreggiani M, Marchi G, Dal Canton A. Effects of sirolimus on human mesangial cells. Transplant Proc 2010; 42:1344-6. [PMID: 20534297 DOI: 10.1016/j.transproceed.2010.03.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mesangial cell (MC) proliferation and production of extracellular matrix or loss of MC are both central findings in a number of renal proteinuric diseases. However, the role of MC as components of the glomerular filtration barrier and whether MC alterations induce changes in the glomerular filtration barrier leading to proteinuria are still matters of debate. The effects of Sirolimus (SRL) in proteinuric nephropathies is controversial: some papers have indicated a reduction and others, an increase in proteinuria after sirolimus treatment. Considering the pivotal role of MC in the pathogenesis of many chronic nephropathies, we evaluated the effect of SRL on cultured human MC. We treated primary human MC cultures with SRL, or platelet-derived growth factor (PDGF) or SRL + PDGF, or dimethylsulfoxide, the SRL vehicle, as a control. PDGF was used to activate MC. After 48 hours treatment, MC showed a significant growth increase that was significantly reduced by SRL (P < .01). Apoptosis, determined by the TUNEL assay and flow cytometry, was not modified by the treatments at 24 hours. SRL treatment increased significantly the number of alpha-smooth muscle actin-positive cells compared with controls (P < .05). Cells treated with SRL and SRL + PDGF showed significant changes in morphology with increased mean cell surface, perimeter, and maximum diameter (P < .01) but not protein content. Furthermore, MC treated with SRL showed decreased migration through polycarbonate membranes. The changes induced by SRL may help to explain some of the in vivo effects observed in SRL-treated patients.
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Affiliation(s)
- C Esposito
- Unit of Nephrology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
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Esposito C, Grosjean F, Torreggiani M, Maggi N, Esposito V, Migotto C, Mangione F, Tinelli C, Dal Canton A. Increased asymmetric dimethylarginine serum levels are associated with acute rejection in kidney transplant recipients. Transplant Proc 2009; 41:1570-3. [PMID: 19545681 DOI: 10.1016/j.transproceed.2009.03.074] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Revised: 03/01/2009] [Accepted: 03/11/2009] [Indexed: 11/19/2022]
Abstract
Asymmetric dimethylarginine (ADMA) has been identified as a marker of endothelial dysfunction and an independent risk factor for cardiovascular events in uremic subjects. This study evaluated ADMA plasma levels in kidney transplant recipients. ADMA levels were serially measured during the first year posttransplantation in 41 recipients treated with cyclosporine regimen (CY), sirolimus (SIR), or low-dose cyclosporine plus everolimus (E). Homocysteine, C reactive protein (CRP), nitric oxide (NO), and standard routine laboratory analyses were determined serially. ADMA significantly increased at 6 months posttransplantation, but was significantly lower among patients on SIR or E. NO was only slightly reduced in patients with increased ADMA levels. Interestingly, ADMA was significantly increased during the first 4 days posttransplantation in patients who experienced acute rejection during the first 6 months after transplantation. The same group of patients demonstrated higher levels of CRP and systolic blood pressure before transplantation. Our results demonstrated that ADMA was increased in patients on CY at 6 months. When increased soon after transplantation ADMA may be associated with episodes of acute rejection in kidney transplant recipients. The presence of elevated systolic blood pressure, as well as CRP and ADMA levels, suggested a role for endothelial dysfunction in the development of acute rejection episodes among deceased donor kidney transplant recipients.
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Affiliation(s)
- C Esposito
- Unit of Nephrology, Dialysis and Transplantation, Policlinico San Matteo, University of Pavia, Pavia, Italy.
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Casini G, De Laurentis N, Maggi N, Ottolino S. [Protective effect of esters of p-hydroxybenzoic acid on the photodegradation of riboflavin]. Farmaco Prat 1981; 36:553-8. [PMID: 7319021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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26
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Maggi N, Birrante A, Callanni C. [New method of colorimetric determination of tetracycline]. Farmaco Prat 1973; 28:175-83. [PMID: 4691583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Maggi N, Casavecchia G, Cavatorta L. [Automatic determination of L-DOPA in extracts of natural origin]. Farmaco Prat 1970; 25:297-302. [PMID: 5451633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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30
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Maggi N. [Round shadow of the lung of different radiological interpretation and uncommon pathogenesis]. Nunt Radiol 1969; 35:485-92. [PMID: 5406683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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31
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Maggi N, Furesz S, Pallanza R, Pelizza G. Rifampicin desacetylation in the human organism. Arzneimittelforschung 1969; 19:651-4. [PMID: 5819167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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32
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Maggi N, Arioli V, Tamborini G. [Pyrrolo-rifamycin: synthesis and antibacterial properties]. Farmaco Sci 1969; 24:263-75. [PMID: 4388811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Pasqualucci CR, Vigevani A, Radaelli P, Maggi N. [Spectrophotometric analysis of rifampicin]. Farmaco Prat 1969; 24:46-52. [PMID: 5779031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Catucci G, Maggi N. [Case of serious gastric hemorrhage of unusual etiology: gastric neurinoma]. Nunt Radiol 1969; 35:89-96. [PMID: 5408319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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35
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Camponovo LE, Maggi N. [On the pharmacology of the blood sugar decreasing substance Glycodiazine]. Arzneimittelforschung 1968; 18:577-80. [PMID: 5755885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Maggi N, Gallo GG, Sensi P. Synthesis of 3-formylrifamycin SV. Farmaco Sci 1967; 22:316-325. [PMID: 6054933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Maggi N, Pallanza R. 3-(S-substituted)thiorifamycins: synthesis and antibacterial properties. Farmaco Sci 1967; 22:307-15. [PMID: 6054932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Martinelli L, Maggi N. [On 2 cases of celomic cyst of the mediastinum]. Rev Bras Biol 1966; 26:1401-16. [PMID: 5999436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Gallo GG, Pasqualucci CR, Maggi N, Ballotta R, Sensi P. Rifamycins. XLII. Rifazine, a new phenazinic derivative of rifamycins. Farmaco Sci 1966; 21:68-75. [PMID: 5940251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Maggi N, Arioli V, Sensi P. Rifamycins. XLI. A new class of active semisynthetic rifamycins. N-substituted aminomethyl derivatives of rifamycin SV 2. J Med Chem 1965; 8:790-3. [PMID: 5885073 DOI: 10.1021/jm00330a013] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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