Abstract ES5-2: Regional Management of the Axilla prior to Systemic Therapy

Abstract

Abstract There is growing interest in personalizing axillary management strategies based on anatomic staging and receptor profile to minimize surgical morbidity and maximize oncologic outcomes. Axillary treatment decision making has become increasing complex given the variation in indications for axillary lymph node dissection (ALND) among clinically node negative patients based on treatment strategy. Current techniques to minimize the likelihood of requiring an ALND include application of the ACOSOG Z011 or AMAROS data for women undergoing surgery first or use of neoadjuvant chemotherapy (NAC) in attempts to downstage microscopic nodal disease. Hormone receptor positive, HER2 negative tumors have low pathologic complete response rates to NAC and therefore have low rates of axillary downstaging with this approach. We have evaluated the likelihood of requiring an ALND by receptor profile for differing management strategies. Given the low response rates to NAC among women with hormone receptor positive, HER2- tumors, use of NAC for this subtype is associated with a threefold increase in the receipt of ALND compared to those treated with upfront breast conserving surgery. In this session I will review the current strategies to minimize the likelihood of requiring an ALND among clinically node negative patients found to have a positive sentinel lymph node including application of the ACOSOG Z0011 and AMAROS strategies. I will also review the impact of axillary imaging and/or a positive lymph node needle biopsy on axillary surgery outcomes among clinically node negative patients. Having an understanding of these differing options will aid in personalizing axillary management recommendations to safely minimize the likelihood of ALND and the resultant risk of lymphedema. Citation Format: M Pilewskie. Regional Management of the Axilla prior to Systemic Therapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr ES5-2.