Real de-escalation or escalation in disguise?

The past two decades have seen an unprecedented trend towards de-escalation of surgical therapy in the setting of early BC, the most prominent examples being the reduction of re-excision rates for close surgical margins after breast-conserving surgery and replacing axillary lymph node dissection by...
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Gespeichert in:

Autor*in:	Maggie Banys-Paluchowski [verfasserIn] Isabel T. Rubio [verfasserIn] Nina Ditsch [verfasserIn] David Krug [verfasserIn] Oreste Davide Gentilini [verfasserIn] Thorsten Kühn [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2023

Schlagwörter:	Breast surgery de-escalation Contralateral mastectomy Targeted axillary dissection Sentinel lymph node biopsy

Übergeordnetes Werk:	In: Breast - Elsevier, 2020, 69(2023), Seite 249-257
Übergeordnetes Werk:	volume:69 ; year:2023 ; pages:249-257

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1016/j.breast.2023.03.001

Katalog-ID:	DOAJ088184080

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allfields	10.1016/j.breast.2023.03.001 doi (DE-627)DOAJ088184080 (DE-599)DOAJ751b4d54fc1a4a6f8b7b1ea4eb4a4aaa DE-627 ger DE-627 rakwb eng RC254-282 Maggie Banys-Paluchowski verfasserin aut Real de-escalation or escalation in disguise? 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier The past two decades have seen an unprecedented trend towards de-escalation of surgical therapy in the setting of early BC, the most prominent examples being the reduction of re-excision rates for close surgical margins after breast-conserving surgery and replacing axillary lymph node dissection by less radical procedures such as sentinel lymph node biopsy (SLNB). Numerous studies confirmed that reducing the extent of surgery in the upfront surgery setting does not impact locoregional recurrences and overall outcome. In the setting of primary systemic treatment, there is an increased use of less invasive staging strategies reaching from SLNB and targeted lymph node biopsy (TLNB) to targeted axillary dissection (TAD). Omission of any axillary surgery in the presence of pathological complete response in the breast is currently being investigated in clinical trials. On the other hand, concerns have been raised that surgical de-escalation might induce an escalation of other treatment modalities such as radiation therapy. Since most trials on surgical de-escalation did not include standardized protocols for adjuvant radiotherapy, it remains unclear, whether the effect of surgical de-escalation was valid in itself or if radiotherapy compensated for the decreased surgical extent. Uncertainties in scientific evidence may therefore lead to escalation of radiotherapy in some settings of surgical de-escalation. Further, the increasing rate of mastectomies including contralateral procedures in patients without genetic risk is alarming. Future studies of locoregional treatment strategies need to include an interdisciplinary approach to integrate de-escalation approaches combining surgery and radiotherapy in a way that promotes optimal quality of life and shared decision-making. Breast surgery de-escalation Contralateral mastectomy Targeted axillary dissection Sentinel lymph node biopsy Neoplasms. Tumors. Oncology. Including cancer and carcinogens Isabel T. Rubio verfasserin aut Nina Ditsch verfasserin aut David Krug verfasserin aut Oreste Davide Gentilini verfasserin aut Thorsten Kühn verfasserin aut In Breast Elsevier, 2020 69(2023), Seite 249-257 (DE-627)320475042 (DE-600)2009043-2 15323080 nnns volume:69 year:2023 pages:249-257 https://doi.org/10.1016/j.breast.2023.03.001 kostenfrei https://doaj.org/article/751b4d54fc1a4a6f8b7b1ea4eb4a4aaa kostenfrei http://www.sciencedirect.com/science/article/pii/S0960977623000577 kostenfrei https://doaj.org/toc/1532-3080 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_165 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2008 GBV_ILN_2014 GBV_ILN_2034 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2064 GBV_ILN_2106 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 69 2023 249-257
spelling	10.1016/j.breast.2023.03.001 doi (DE-627)DOAJ088184080 (DE-599)DOAJ751b4d54fc1a4a6f8b7b1ea4eb4a4aaa DE-627 ger DE-627 rakwb eng RC254-282 Maggie Banys-Paluchowski verfasserin aut Real de-escalation or escalation in disguise? 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier The past two decades have seen an unprecedented trend towards de-escalation of surgical therapy in the setting of early BC, the most prominent examples being the reduction of re-excision rates for close surgical margins after breast-conserving surgery and replacing axillary lymph node dissection by less radical procedures such as sentinel lymph node biopsy (SLNB). Numerous studies confirmed that reducing the extent of surgery in the upfront surgery setting does not impact locoregional recurrences and overall outcome. In the setting of primary systemic treatment, there is an increased use of less invasive staging strategies reaching from SLNB and targeted lymph node biopsy (TLNB) to targeted axillary dissection (TAD). Omission of any axillary surgery in the presence of pathological complete response in the breast is currently being investigated in clinical trials. On the other hand, concerns have been raised that surgical de-escalation might induce an escalation of other treatment modalities such as radiation therapy. Since most trials on surgical de-escalation did not include standardized protocols for adjuvant radiotherapy, it remains unclear, whether the effect of surgical de-escalation was valid in itself or if radiotherapy compensated for the decreased surgical extent. Uncertainties in scientific evidence may therefore lead to escalation of radiotherapy in some settings of surgical de-escalation. Further, the increasing rate of mastectomies including contralateral procedures in patients without genetic risk is alarming. Future studies of locoregional treatment strategies need to include an interdisciplinary approach to integrate de-escalation approaches combining surgery and radiotherapy in a way that promotes optimal quality of life and shared decision-making. Breast surgery de-escalation Contralateral mastectomy Targeted axillary dissection Sentinel lymph node biopsy Neoplasms. Tumors. Oncology. Including cancer and carcinogens Isabel T. Rubio verfasserin aut Nina Ditsch verfasserin aut David Krug verfasserin aut Oreste Davide Gentilini verfasserin aut Thorsten Kühn verfasserin aut In Breast Elsevier, 2020 69(2023), Seite 249-257 (DE-627)320475042 (DE-600)2009043-2 15323080 nnns volume:69 year:2023 pages:249-257 https://doi.org/10.1016/j.breast.2023.03.001 kostenfrei https://doaj.org/article/751b4d54fc1a4a6f8b7b1ea4eb4a4aaa kostenfrei http://www.sciencedirect.com/science/article/pii/S0960977623000577 kostenfrei https://doaj.org/toc/1532-3080 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_165 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2008 GBV_ILN_2014 GBV_ILN_2034 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2064 GBV_ILN_2106 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 69 2023 249-257
allfields_unstemmed	10.1016/j.breast.2023.03.001 doi (DE-627)DOAJ088184080 (DE-599)DOAJ751b4d54fc1a4a6f8b7b1ea4eb4a4aaa DE-627 ger DE-627 rakwb eng RC254-282 Maggie Banys-Paluchowski verfasserin aut Real de-escalation or escalation in disguise? 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier The past two decades have seen an unprecedented trend towards de-escalation of surgical therapy in the setting of early BC, the most prominent examples being the reduction of re-excision rates for close surgical margins after breast-conserving surgery and replacing axillary lymph node dissection by less radical procedures such as sentinel lymph node biopsy (SLNB). Numerous studies confirmed that reducing the extent of surgery in the upfront surgery setting does not impact locoregional recurrences and overall outcome. In the setting of primary systemic treatment, there is an increased use of less invasive staging strategies reaching from SLNB and targeted lymph node biopsy (TLNB) to targeted axillary dissection (TAD). Omission of any axillary surgery in the presence of pathological complete response in the breast is currently being investigated in clinical trials. On the other hand, concerns have been raised that surgical de-escalation might induce an escalation of other treatment modalities such as radiation therapy. Since most trials on surgical de-escalation did not include standardized protocols for adjuvant radiotherapy, it remains unclear, whether the effect of surgical de-escalation was valid in itself or if radiotherapy compensated for the decreased surgical extent. Uncertainties in scientific evidence may therefore lead to escalation of radiotherapy in some settings of surgical de-escalation. Further, the increasing rate of mastectomies including contralateral procedures in patients without genetic risk is alarming. Future studies of locoregional treatment strategies need to include an interdisciplinary approach to integrate de-escalation approaches combining surgery and radiotherapy in a way that promotes optimal quality of life and shared decision-making. Breast surgery de-escalation Contralateral mastectomy Targeted axillary dissection Sentinel lymph node biopsy Neoplasms. Tumors. Oncology. Including cancer and carcinogens Isabel T. Rubio verfasserin aut Nina Ditsch verfasserin aut David Krug verfasserin aut Oreste Davide Gentilini verfasserin aut Thorsten Kühn verfasserin aut In Breast Elsevier, 2020 69(2023), Seite 249-257 (DE-627)320475042 (DE-600)2009043-2 15323080 nnns volume:69 year:2023 pages:249-257 https://doi.org/10.1016/j.breast.2023.03.001 kostenfrei https://doaj.org/article/751b4d54fc1a4a6f8b7b1ea4eb4a4aaa kostenfrei http://www.sciencedirect.com/science/article/pii/S0960977623000577 kostenfrei https://doaj.org/toc/1532-3080 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_165 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2008 GBV_ILN_2014 GBV_ILN_2034 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2064 GBV_ILN_2106 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 69 2023 249-257
allfieldsGer	10.1016/j.breast.2023.03.001 doi (DE-627)DOAJ088184080 (DE-599)DOAJ751b4d54fc1a4a6f8b7b1ea4eb4a4aaa DE-627 ger DE-627 rakwb eng RC254-282 Maggie Banys-Paluchowski verfasserin aut Real de-escalation or escalation in disguise? 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier The past two decades have seen an unprecedented trend towards de-escalation of surgical therapy in the setting of early BC, the most prominent examples being the reduction of re-excision rates for close surgical margins after breast-conserving surgery and replacing axillary lymph node dissection by less radical procedures such as sentinel lymph node biopsy (SLNB). Numerous studies confirmed that reducing the extent of surgery in the upfront surgery setting does not impact locoregional recurrences and overall outcome. In the setting of primary systemic treatment, there is an increased use of less invasive staging strategies reaching from SLNB and targeted lymph node biopsy (TLNB) to targeted axillary dissection (TAD). Omission of any axillary surgery in the presence of pathological complete response in the breast is currently being investigated in clinical trials. On the other hand, concerns have been raised that surgical de-escalation might induce an escalation of other treatment modalities such as radiation therapy. Since most trials on surgical de-escalation did not include standardized protocols for adjuvant radiotherapy, it remains unclear, whether the effect of surgical de-escalation was valid in itself or if radiotherapy compensated for the decreased surgical extent. Uncertainties in scientific evidence may therefore lead to escalation of radiotherapy in some settings of surgical de-escalation. Further, the increasing rate of mastectomies including contralateral procedures in patients without genetic risk is alarming. Future studies of locoregional treatment strategies need to include an interdisciplinary approach to integrate de-escalation approaches combining surgery and radiotherapy in a way that promotes optimal quality of life and shared decision-making. Breast surgery de-escalation Contralateral mastectomy Targeted axillary dissection Sentinel lymph node biopsy Neoplasms. Tumors. Oncology. Including cancer and carcinogens Isabel T. Rubio verfasserin aut Nina Ditsch verfasserin aut David Krug verfasserin aut Oreste Davide Gentilini verfasserin aut Thorsten Kühn verfasserin aut In Breast Elsevier, 2020 69(2023), Seite 249-257 (DE-627)320475042 (DE-600)2009043-2 15323080 nnns volume:69 year:2023 pages:249-257 https://doi.org/10.1016/j.breast.2023.03.001 kostenfrei https://doaj.org/article/751b4d54fc1a4a6f8b7b1ea4eb4a4aaa kostenfrei http://www.sciencedirect.com/science/article/pii/S0960977623000577 kostenfrei https://doaj.org/toc/1532-3080 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_165 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2008 GBV_ILN_2014 GBV_ILN_2034 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2064 GBV_ILN_2106 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 69 2023 249-257
allfieldsSound	10.1016/j.breast.2023.03.001 doi (DE-627)DOAJ088184080 (DE-599)DOAJ751b4d54fc1a4a6f8b7b1ea4eb4a4aaa DE-627 ger DE-627 rakwb eng RC254-282 Maggie Banys-Paluchowski verfasserin aut Real de-escalation or escalation in disguise? 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier The past two decades have seen an unprecedented trend towards de-escalation of surgical therapy in the setting of early BC, the most prominent examples being the reduction of re-excision rates for close surgical margins after breast-conserving surgery and replacing axillary lymph node dissection by less radical procedures such as sentinel lymph node biopsy (SLNB). Numerous studies confirmed that reducing the extent of surgery in the upfront surgery setting does not impact locoregional recurrences and overall outcome. In the setting of primary systemic treatment, there is an increased use of less invasive staging strategies reaching from SLNB and targeted lymph node biopsy (TLNB) to targeted axillary dissection (TAD). Omission of any axillary surgery in the presence of pathological complete response in the breast is currently being investigated in clinical trials. On the other hand, concerns have been raised that surgical de-escalation might induce an escalation of other treatment modalities such as radiation therapy. Since most trials on surgical de-escalation did not include standardized protocols for adjuvant radiotherapy, it remains unclear, whether the effect of surgical de-escalation was valid in itself or if radiotherapy compensated for the decreased surgical extent. Uncertainties in scientific evidence may therefore lead to escalation of radiotherapy in some settings of surgical de-escalation. Further, the increasing rate of mastectomies including contralateral procedures in patients without genetic risk is alarming. Future studies of locoregional treatment strategies need to include an interdisciplinary approach to integrate de-escalation approaches combining surgery and radiotherapy in a way that promotes optimal quality of life and shared decision-making. Breast surgery de-escalation Contralateral mastectomy Targeted axillary dissection Sentinel lymph node biopsy Neoplasms. Tumors. Oncology. Including cancer and carcinogens Isabel T. Rubio verfasserin aut Nina Ditsch verfasserin aut David Krug verfasserin aut Oreste Davide Gentilini verfasserin aut Thorsten Kühn verfasserin aut In Breast Elsevier, 2020 69(2023), Seite 249-257 (DE-627)320475042 (DE-600)2009043-2 15323080 nnns volume:69 year:2023 pages:249-257 https://doi.org/10.1016/j.breast.2023.03.001 kostenfrei https://doaj.org/article/751b4d54fc1a4a6f8b7b1ea4eb4a4aaa kostenfrei http://www.sciencedirect.com/science/article/pii/S0960977623000577 kostenfrei https://doaj.org/toc/1532-3080 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_165 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2008 GBV_ILN_2014 GBV_ILN_2034 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2064 GBV_ILN_2106 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 69 2023 249-257
language	English
source	In Breast 69(2023), Seite 249-257 volume:69 year:2023 pages:249-257
sourceStr	In Breast 69(2023), Seite 249-257 volume:69 year:2023 pages:249-257
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Breast surgery de-escalation Contralateral mastectomy Targeted axillary dissection Sentinel lymph node biopsy Neoplasms. Tumors. Oncology. Including cancer and carcinogens
isfreeaccess_bool	true
container_title	Breast
authorswithroles_txt_mv	Maggie Banys-Paluchowski @@aut@@ Isabel T. Rubio @@aut@@ Nina Ditsch @@aut@@ David Krug @@aut@@ Oreste Davide Gentilini @@aut@@ Thorsten Kühn @@aut@@
publishDateDaySort_date	2023-01-01T00:00:00Z
hierarchy_top_id	320475042
id	DOAJ088184080
language_de	englisch
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callnumber-first	R - Medicine
author	Maggie Banys-Paluchowski
spellingShingle	Maggie Banys-Paluchowski misc RC254-282 misc Breast surgery misc de-escalation misc Contralateral mastectomy misc Targeted axillary dissection misc Sentinel lymph node biopsy misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens Real de-escalation or escalation in disguise?
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topic_title	RC254-282 Real de-escalation or escalation in disguise? Breast surgery de-escalation Contralateral mastectomy Targeted axillary dissection Sentinel lymph node biopsy
topic	misc RC254-282 misc Breast surgery misc de-escalation misc Contralateral mastectomy misc Targeted axillary dissection misc Sentinel lymph node biopsy misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
topic_unstemmed	misc RC254-282 misc Breast surgery misc de-escalation misc Contralateral mastectomy misc Targeted axillary dissection misc Sentinel lymph node biopsy misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
topic_browse	misc RC254-282 misc Breast surgery misc de-escalation misc Contralateral mastectomy misc Targeted axillary dissection misc Sentinel lymph node biopsy misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
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title	Real de-escalation or escalation in disguise?
ctrlnum	(DE-627)DOAJ088184080 (DE-599)DOAJ751b4d54fc1a4a6f8b7b1ea4eb4a4aaa
title_full	Real de-escalation or escalation in disguise?
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author_browse	Maggie Banys-Paluchowski Isabel T. Rubio Nina Ditsch David Krug Oreste Davide Gentilini Thorsten Kühn
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title_sort	real de-escalation or escalation in disguise?
callnumber	RC254-282
title_auth	Real de-escalation or escalation in disguise?
abstract	The past two decades have seen an unprecedented trend towards de-escalation of surgical therapy in the setting of early BC, the most prominent examples being the reduction of re-excision rates for close surgical margins after breast-conserving surgery and replacing axillary lymph node dissection by less radical procedures such as sentinel lymph node biopsy (SLNB). Numerous studies confirmed that reducing the extent of surgery in the upfront surgery setting does not impact locoregional recurrences and overall outcome. In the setting of primary systemic treatment, there is an increased use of less invasive staging strategies reaching from SLNB and targeted lymph node biopsy (TLNB) to targeted axillary dissection (TAD). Omission of any axillary surgery in the presence of pathological complete response in the breast is currently being investigated in clinical trials. On the other hand, concerns have been raised that surgical de-escalation might induce an escalation of other treatment modalities such as radiation therapy. Since most trials on surgical de-escalation did not include standardized protocols for adjuvant radiotherapy, it remains unclear, whether the effect of surgical de-escalation was valid in itself or if radiotherapy compensated for the decreased surgical extent. Uncertainties in scientific evidence may therefore lead to escalation of radiotherapy in some settings of surgical de-escalation. Further, the increasing rate of mastectomies including contralateral procedures in patients without genetic risk is alarming. Future studies of locoregional treatment strategies need to include an interdisciplinary approach to integrate de-escalation approaches combining surgery and radiotherapy in a way that promotes optimal quality of life and shared decision-making.
abstractGer	The past two decades have seen an unprecedented trend towards de-escalation of surgical therapy in the setting of early BC, the most prominent examples being the reduction of re-excision rates for close surgical margins after breast-conserving surgery and replacing axillary lymph node dissection by less radical procedures such as sentinel lymph node biopsy (SLNB). Numerous studies confirmed that reducing the extent of surgery in the upfront surgery setting does not impact locoregional recurrences and overall outcome. In the setting of primary systemic treatment, there is an increased use of less invasive staging strategies reaching from SLNB and targeted lymph node biopsy (TLNB) to targeted axillary dissection (TAD). Omission of any axillary surgery in the presence of pathological complete response in the breast is currently being investigated in clinical trials. On the other hand, concerns have been raised that surgical de-escalation might induce an escalation of other treatment modalities such as radiation therapy. Since most trials on surgical de-escalation did not include standardized protocols for adjuvant radiotherapy, it remains unclear, whether the effect of surgical de-escalation was valid in itself or if radiotherapy compensated for the decreased surgical extent. Uncertainties in scientific evidence may therefore lead to escalation of radiotherapy in some settings of surgical de-escalation. Further, the increasing rate of mastectomies including contralateral procedures in patients without genetic risk is alarming. Future studies of locoregional treatment strategies need to include an interdisciplinary approach to integrate de-escalation approaches combining surgery and radiotherapy in a way that promotes optimal quality of life and shared decision-making.
abstract_unstemmed	The past two decades have seen an unprecedented trend towards de-escalation of surgical therapy in the setting of early BC, the most prominent examples being the reduction of re-excision rates for close surgical margins after breast-conserving surgery and replacing axillary lymph node dissection by less radical procedures such as sentinel lymph node biopsy (SLNB). Numerous studies confirmed that reducing the extent of surgery in the upfront surgery setting does not impact locoregional recurrences and overall outcome. In the setting of primary systemic treatment, there is an increased use of less invasive staging strategies reaching from SLNB and targeted lymph node biopsy (TLNB) to targeted axillary dissection (TAD). Omission of any axillary surgery in the presence of pathological complete response in the breast is currently being investigated in clinical trials. On the other hand, concerns have been raised that surgical de-escalation might induce an escalation of other treatment modalities such as radiation therapy. Since most trials on surgical de-escalation did not include standardized protocols for adjuvant radiotherapy, it remains unclear, whether the effect of surgical de-escalation was valid in itself or if radiotherapy compensated for the decreased surgical extent. Uncertainties in scientific evidence may therefore lead to escalation of radiotherapy in some settings of surgical de-escalation. Further, the increasing rate of mastectomies including contralateral procedures in patients without genetic risk is alarming. Future studies of locoregional treatment strategies need to include an interdisciplinary approach to integrate de-escalation approaches combining surgery and radiotherapy in a way that promotes optimal quality of life and shared decision-making.
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title_short	Real de-escalation or escalation in disguise?
url	https://doi.org/10.1016/j.breast.2023.03.001 https://doaj.org/article/751b4d54fc1a4a6f8b7b1ea4eb4a4aaa http://www.sciencedirect.com/science/article/pii/S0960977623000577 https://doaj.org/toc/1532-3080
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score	7.3988447

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