New concept of de-escalation management strategy in breast cancer patients with 1-2 positive sentinel lymph nodes

Abstract

In the era of sentinel lymph node biopsy (SLNB), the axillary management concept that 1-2 positive sentinel lymph node (SLN) could safely omit axillary lymph node dissection (ALND) are gradually being accepted by more and more patients. The omission of ALND is safe with no difference in regional recurrence in early breast cancer patients with limited SLN involvement. With the effective support and supplement of systemic therapy and radiotherapy, the management concept of axilla surgery is developing in a de-escalating trend. The combined application of multi-gene tests and ACSOG Z0011/AMAROS criteria could provide patients with a better strategy of dual de-escalation treatment, which includes the de-escalation of both axillary surgery and systemic treatment. In clinical practice, it is necessary to combine the residual tumor burden of regional lymph nodes to formulate the optimal irradiation fields in patients with 1-2 positive SLNs without ALND. In the era of SLNB, we can make full use of the benefits of systemic therapy and radiotherapy to reasonably reduce the scope of surgery and complications, therefore expand the "net benefit" of efficacy and quality of life. This paper reviewed the optimization of the de-escalation strategy concept for systemic and regional management in patients with 1-2 positive SLNs.

Keywords

• |breast cancer|sentinel lymph node biopsy|multi-gene test|radiotherapy