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. 2012 Feb;7(1):61-66.
doi: 10.1159/000336983. Epub 2012 Feb 20.

Results of the First Austrian Multidisciplinary Expert Panel on Controversies in Local Treatment of Breast Cancer

Michael Knauer  1 , Michael Gnant, Florian Fitzal
Affiliations

Results of the First Austrian Multidisciplinary Expert Panel on Controversies in Local Treatment of Breast Cancer

Michael Knauer et al. Breast Care (Basel). 2012 Feb.

Abstract
in English, German

At the first Austrian multidisciplinary expert panel on controversies in local treatment of breast cancer, 22 experts of all relevant disciplines discussed current areas of debate (surgery of the breast, surgery and pathology of the axilla, reconstructive surgery, radiotherapy, and imaging) in local therapy. The most controversial area of debate was the area of axillary surgery. The panel agreed that it was no longer necessary to perform completion axillary lymph node dissection (ALND) when micrometastases are diagnosed in the sentinel lymph node. The only prospective trial comparing patients with sentinel node macrometastases with or without completion ALND had to be terminated early due to failure in sufficient patient recruitment. As long as the frequently discussed issues have not been solved and in light of the lack of any clear level 1 evidence, the panel decided not to recommend omitting axillary dissection in patients with 1 or 2 macrometastases meeting the inclusion criteria of the ACOSOG Z0011 trial. The Austrian panel similarly decided not to recommend omitting axillary dissection in patients with macrometastases and low-risk breast cancer in general. These decisions reflect the increasing skepticism of the scientific community against rapidly shifting paradigms without sufficient and clear evidence.

Beim ersten österreichischen interdisziplinären Expertenpanel zum Thema «Kontroversen bei der Lokaltherapie des Mammakarzinoms» diskutierten 22 Experten aus allen relevanten Disziplinen Themen aus aktuellen Spannungsfeldern (Chirurgie der Brust, Chirurgie und Pathologie der Axilla, rekonstruktive Chirurgie, Strahlentherapie und Bildgebung). Das am kontroversesten diskutierte Thema war die Chirurgie der Axilla. Das Panel war der Meinung, dass eine komplettierende Axilladissektion bei Mikrometastasen im Wächterlymphknoten (Sentinel Node) nicht mehr notwendig ist. Die einzige prospektive Studie, die bei Patientinnen mit Makrometastasen im Sentinel Node die Axilladissektion randomisiert untersuchte, musste aufgrund unzureichender Rekrutierung frühzeitig geschlossen werden. Bis die häufig diskutierten Probleme in dieser Studie geklärt sind und in Ermangelung von klarer Level-1-Evidenz hat sich das Panel dazu entschieden, den Verzicht auf die Axilladissektion bei Patientinnen mit 1–2 Makrometastasen, die den Einschlusskriterien von ACOSOG Z0011 entsprechen, nicht zu empfehlen. Ebensowenig wurde der Verzicht auf Axilladissektion bei Patientinnen mit Makrometastasen und biologischem Low-risk-Karzinom im Allgemeinen empfohlen, was die zunehmende Skepsis der wissenschaftlichen Gemeinschaft gegenüber einem allzu schnellem Paradigmenwechsel ohne ausreichende und klare Evidenz widerspiegelt.

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