Sentinel Node Biopsy for Early Breast Cancer—A SOUND for De-escalation
Mené sur 1 463 femmes atteintes d'un cancer du sein de stade précoce sans atteinte axillaire selon les résultats de l'échographie pré-opératoire (âge médian : 60 ans ; taille de la tumeur : jusqu'à 2 cm), cet essai international de phase 3 évalue la non infériorité, du point de vue de la survie sans maladie distante à 5 ans, de l'absence de chirurgie axillaire par rapport à une biopsie du ganglion sentinelle
The evolution of axillary surgery for patients with breast cancer represents a model of patient-centered, evidence-based de-escalation of therapy. Starting with the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-04 trial, published over 40 years ago, where the principle of axillary dissection mainly as a staging procedure was first enunciated, the trajectory of this operation has steadily progressed in the direction that “less is more.” Following NSABP B-04, the motivation for providing axillary dissection became the joint imperative of accurate nodal staging and local control. This paradigm persisted until the evidence-based replacement of axillary dissection with the far less morbid approach of sentinel node biopsy for pathological staging of the clinically negative axilla. The use of axillary dissection was further eroded by the landmark American College of Surgeons Oncology Group Z0011 trial, which demonstrated that diseased lymph nodes could be left intact without impairing breast cancer outcomes, given effective systemic therapy. Most recently, the 10-year results of the AMAROS trial demonstrated equivalent outcomes in women who received axillary dissection or axillary radiotherapy for limited nodal disease in the axilla, with reduced rates of arm lymphedema.
JAMA Oncology , éditorial, 2022