Annals of Surgical Oncology | 2021
ASO Author Reflections: Selective Nodal Staging and De-escalating Adjuvant Therapy
Abstract
Treatment for breast cancer has evolved significantly in the past 50 years with the de-escalation of surgical treatment to routine use of lumpectomy and sentinel node biopsy (SLNB) and tailored adjuvant treatment based on tumor stage and biology. Choosing Wisely recommended selective axillary staging in women over 70 years with ERpositive cancers based on trials showing equivalent outcomes when axillary dissection (ALND) was omitted in early-stage breast cancer, but since these trials, surgical management of the axilla has changed from ALND to SLNB. Simultaneously, trials have demonstrated that partial breast irradiation (PBI) has lower toxicity than traditional whole breast irradiation (WBI), and other trials are looking at de-escalating hormone therapy. However, these trials de-escalating radiation and hormone therapy in older women have required pathologically negative nodal status, which has led to uncertainty about which of these therapies can be omitted when the axilla is not staged.