Breast (Dec 2021)
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)
- Walter P. Weber,
- Zoltan Matrai,
- Stefanie Hayoz,
- Christoph Tausch,
- Guido Henke,
- Daniel R. Zwahlen,
- Günther Gruber,
- Frank Zimmermann,
- Stefanie Seiler,
- Charlotte Maddox,
- Thomas Ruhstaller,
- Simone Muenst,
- Markus Ackerknecht,
- Sherko Kuemmel,
- Vesna Bjelic-Radisic,
- Christian Kurzeder,
- Mihály Újhelyi,
- 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,
- Peter Dubsky,
- Ruth Exner,
- Hisham Fansa,
- Christopher Hager,
- Klaus Reisenberger,
- Christian F. Singer,
- Roland Reitsamer,
- Mattea Reinisch,
- Jelena Winkler,
- Giang Thanh Lam,
- Mathias K. Fehr,
- Tatiana Naydina,
- Magdalena Kohlik,
- Karine Clerc,
- Valerijus Ostapenko,
- Florian Fitzal,
- Rahel Nussbaumer,
- Nadia Maggi,
- Alexandra Schulz,
- Pagona Markellou,
- Loïc Lelièvre,
- Daniel Egle,
- Jörg Heil,
- Michael Knauer
Affiliations
- Walter P. Weber
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland; Corresponding author. Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
- Zoltan Matrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary; University of Szeged, H-6725 Szeged, Hungary
- Stefanie Hayoz
- SAKK Coordinating Center, Bern, Switzerland
- Christoph Tausch
- Breast Center Zurich, Zurich, Switzerland
- 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
- Stefanie Seiler
- SAKK Coordinating Center, Bern, Switzerland
- Charlotte Maddox
- SAKK Coordinating Center, Bern, Switzerland
- Thomas Ruhstaller
- 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
- Markus Ackerknecht
- University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel, Basel, Switzerland
- Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Vesna Bjelic-Radisic
- Breast Unit, Helios University Clinic, University Witten/Herdecke, Germany
- 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
- Natalie Gabriel
- Breast Center, City Hospital Triemli, Zurich, 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
- Gilles Berclaz
- Breast Center Bern, Lindenhof Group, Bern, 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
- Mattea Reinisch
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Jelena Winkler
- Breast Center, Basel Bethesda Hospital, Basel, Switzerland
- Giang Thanh Lam
- Breast Center, University Hospital of Geneva, Geneva, Switzerland
- Mathias K. Fehr
- Breast Center Thurgau, Münsterlingen, Switzerland
- Tatiana Naydina
- Spital Limmattal, Schlieren, Switzerland
- Magdalena Kohlik
- Breast Center, Clinique de Genolier, Genolier, Switzerland
- Karine Clerc
- Brustzentrum Freiburg, Centre du sein Fribourg, Fribourg, Switzerland
- Valerijus Ostapenko
- National Cancer Institute, Vilnius, Lithuania
- 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
- Loïc Lelièvre
- Breast Center, CHUV, Lausanne, 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
- Journal volume & issue
-
Vol. 60
pp. 98 – 110
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.
