Axillary Lymph Node Dissection versus Loco-regional Radiotherapy in Management of the Axilla in Node-Negative Locally Advanced Breast Cancer Post Neoadjuvant Chemotherapy.

Background: the evolution of axillary management in breast cancer has witnessed significant changes in recent decades, leading to an overall reduction in surgical interventions. There have been notable shifts in practice, aiming to minimize morbidity while maintaining oncologic outcomes and accurate staging for newly diagnosed breast cancer patients. These advancements have been facilitated by the improved efficacy of adjuvant therapies. Objective: To compare the outcomes of axillary lymph node dissection (ALND) and loco-regional axillary radiotherapy (ART) on lymphedema and disease recurrence in locally advanced breast cancer (LABC) cases that have shown a downstaging of their axillary status after neoadjuvant chemotherapy (NACT). Material and Methods: sixty patients with LABC with an initial cN1-2 disease showed a downstaging of their axillary status to cN0 after NACT. They were randomized into two groups. The first group (the control group) underwent ALND, while the second group (the study group) had a sentinel lymph node biopsy (SLNB) and post-operative ART. Patients with failed SLNB or positive SLNB were excluded. All patients were followed up for loco-regional recurrence and lymphedema for at least one year. Results: no statistical significance was found between both groups regarding loco-regional recurrence. There was a higher rate of arm lymphedema in the control group. Lymphedema was found in 46.7% of patients who underwent ALND, compared to 13.4% in the study group (patients with SLNB and radiotherapy). Conclusion: axillary radiation after SNLB has shown no difference regarding axillary recurrence when compared to ALND. However, our results were in favor of radiation concerning lymphedema. With all the ongoing research aiming at reducing axillary surgery, this study could be an initiative for a new strategy in LABC.

被引量：- 发表：2024

Axillary Reverse Mapping Using Indocyanine Green and Concurrent Sentinel Lymph Node Biopsy in Breast Cancer Patients with or without Neoadjuvant Systemic Treatment.

Background: the axillary reverse mapping (ARM) procedure aims to preserve the lymphatic drainage structures of the upper extremity during axillary surgery for breast cancer, thereby reducing the risk of lymphedema in the upper limb. Material and Methods: this prospective study included 57 patients with breast cancer who underwent SLNB and ARM. The sentinel lymph node (SLN) was identified using a radioactive tracer. The ARM nodes were identified using indocyanine green with a near-infrared imaging system. All SLNs were examined intraoperatively. If the SLN was metastatic, further surgery was considered. The identified ARM nodes were preserved unless they coincided with the SLN. Results: ARM nodes were visualized in 53 patients (92.94%). Crossover between SLN and ARM nodes was observed in 19 patients, 5 untreated and 14 who received neoadjuvant systemic treatment (NST), resulting in an overall crossover rate of 33.33%. Patients who received NST were more likely to show SLN-ARM crossover (p = 0.015) compared to those who underwent upfront surgery. Of the 20 patients with positive SLNs, 13 had crossover, 5 untreated and 8 received NST. In patients with positive SLN-ARM nodes, additional invaded ARM nodes were identified 7 patients, all of whom received NST. Conclusions: using ARM in patients undergoing SLNB allows a supraselective approach to axillary surgery, aiming to reduce morbidity. In cases where patients underwent upfront surgery all SLN-ARM nodes were found to be metastatic and none of the other fluorescent nodes that were removed showed signs of invasion. The crossover rates are higher in patients with neoadjuvant treatment.

被引量：- 发表：2024

Axillary Lymph Node Dissection versus Loco-regional Radiotherapy in Management of the Axilla in Node-Negative Locally Advanced Breast Cancer Post Neoadjuvant Chemotherapy.

Background: The evolution of axillary management in breast cancer has witnessed significant changes in recent decades, leading to an overall reduction in surgical interventions. There have been notable shifts in practice, aiming to minimize morbidity while maintaining oncologic outcomes and accurate staging for newly diagnosed breast cancer patients. These advancements have been facilitated by the improved efficacy of adjuvant therapies. To compare the outcomes of axillary lymph node dissection (ALND) and loco-regional axillary radiotherapy (ART) on lymphedema and disease recurrence in locally advanced breast cancer (LABC) cases that have shown a downstaging of their axillary status after neoadjuvant chemotherapy (NACT). Material and Methods: Sixty patients with LABC with an initial cN1-2 disease showed a downstaging of their axillary status to cN0 after NACT. They were randomized into two groups. The first group (the control group) underwent ALND, while the second group (the study group) had a sentinel lymph node biopsy (SLNB) and post-operative ART. Patients with failed SLNB or positive SLNB were excluded. All patients were followed up for loco-regional recurrence and lymphedema for at least one year. Results: No Statistical significance was found between both groups regarding loco-regional recurrence. There was a higher rate of arm lymphedema in the control group. Lymphedema was found in 46.7% of patients who underwent ALND, compared to 13.4% in the study group (patients with SLNB and radiotherapy). Axillary radiation after SNLB has shown no difference regarding axillary recurrence when compared to ALND. However, our results were in favor of radiation concerning lymphedema. With all the ongoing research aiming at reducing axillary surgery, this study could be an initiative for a new strategy in LABC. With all the ongoing research aiming at reducing axillary surgery, this study could be an initiative for a new strategy in LABC for patient who have shown down-staging of their axillary status after NACT. Radiotherapy can show better results in the long term with regards lymphedema.

被引量：- 发表：2024

Polymorphisms of CD44 rs187115 as a Predictive Biomarker in Early Colorectal Cancer Diagnostic.

被引量：- 发表：2024

Burn Injuries in the Pediatric Population - The Experience of a Single Center Over a Period of Two Years.

被引量：- 发表：2024