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Cancers
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De-escalation of Axillary and Breast Cancer Surgery in the Setting...
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De-escalation of Axillary and Breast Cancer Surgery in the Setting of Neo-Adjuvant Chemotherapy

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 15 October 2025 | Viewed by 3110

Special Issue Editors

Prof. Dr. Corrado Tinterri

E-Mail Website
Guest Editor
1. Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
2. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
Interests: breast; breast neoplasm; breast cancer; surgery; breast cancer surgery; axilla; axillary surgery
Dr. Damiano Gentile

E-Mail Website
Guest Editor
1. Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
2. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
Interests: breast; breast neoplasm; breast cancer; surgery; breast cancer surgery; axilla; axillary surgery

Special Issue Information

Dear Colleagues,

In recent years, the paradigm of breast cancer (BC) treatment has witnessed significant shifts, especially in the approach to surgical intervention following neo-adjuvant chemotherapy (NAC). Historically, radical surgeries like mastectomy and extensive axillary lymph node dissection were the cornerstones of BC management. However, the introduction and success of NAC have opened avenues for less aggressive surgical techniques, marking a transition towards de-escalation in surgical management. This shift not only aligns with the principles of conservative surgery but also addresses the physical and psychological burdens experienced by patients. The efficacy of NAC in downstaging tumors has provided a compelling rationale for re-evaluating the necessity and extent of subsequent surgeries. In patients exhibiting a favorable or complete response to NAC, the feasibility of less invasive procedures like breast-conserving surgery, sentinel lymph node biopsy, or the omission of surgery altogether is being increasingly considered. The central tenet of this discussion lies in the careful balance between ensuring oncological safety and reducing the morbidity associated with traditional surgical approaches.

Prof. Dr. Corrado Tinterri
Dr. Damiano Gentile
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • breast neoplasm
  • breast cancer
  • surgery
  • breast cancer surgery
  • systemic therapy
  • neo-adjuvant chemotherapy
  • axilla
  • axillary surgery
  • sentinel lymph node biopsy
  • de-escalation surgery

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Published Papers (2 papers)

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Research

11 pages, 497 KiB  
Article
Axillary Overtreatment in Patients with Breast Cancer After Neoadjuvant Chemotherapy in the Current Era of Targeted Axillary Dissection
by Ondřej Zapletal, Jan Žatecký, Lucie Gabrielová, Iveta Selingerová, Miloš Holánek, Petr Burkoň and Oldřich Coufal
Cancers 2025, 17(2), 178; https://doi.org/10.3390/cancers17020178 - 8 Jan 2025
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Abstract
Background: In the current era of targeted axillary dissection (TAD), there are still cases where axillary lymph node dissection (ALND) is indicated, but histopathological examination confirms the regression of nodal metastases (ypN0). In this situation, ALND may represent undesirable overtreatment. Methods: A retrospective [...] Read more.
Background: In the current era of targeted axillary dissection (TAD), there are still cases where axillary lymph node dissection (ALND) is indicated, but histopathological examination confirms the regression of nodal metastases (ypN0). In this situation, ALND may represent undesirable overtreatment. Methods: A retrospective study at the Comprehensive Cancer Centre was conducted based on a prospectively maintained database. Patients who underwent surgery after neoadjuvant chemotherapy (NAC) between 2020 and 2023 were selected, specifically those for whom ALND was directly indicated after NAC. Subsequently, clinical–pathological characteristics were compared between cases with ypN0 and those with persistent metastases (ypN+). The reasons for indicating ALND in ypN0 cases were extracted from the medical records. Results: ALND was indicated in 118 cases across 117 patients, of which ypN0 was observed in 44 cases (37%). There were significantly more ypN0 cases for inflammatory carcinomas (68%), the non-luminal HER2-positive phenotype (76%), and carcinomas with histopathological regression of the primary tumor (76%) or the persistence of only the non-invasive component of ypTis (67%). Typical reasons for ALND in ypN0 cases included inflammatory carcinoma (n = 13, 29.5%), locally advanced carcinoma (n = 5, 11.4%), occult carcinoma (n = 2, 4.5%), or persistent lymphadenopathy on ultrasound examination after NAC, especially in the tumor phenotypes HER2-positive and triple-negative breast cancer (TNBC) (n = 8, 18.2%). Conclusions: Through real-world evidence data analysis, subgroups of breast cancer patients treated with NAC were identified who may experience surgical overtreatment in the axilla. These include patients with inflammatory carcinoma, locally advanced carcinoma, occult carcinoma, or patients with persistent lymphadenopathy on US examination after NAC, particularly in the tumor phenotypes HER2-positive and TNBC. Full article
(This article belongs to the Special Issue De-escalation of Axillary and Breast Cancer Surgery in the Setting of Neo-Adjuvant Chemotherapy)
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12 pages, 900 KiB  
Article
De-Escalation Surgery in cT3-4 Breast Cancer Patients after Neoadjuvant Therapy: Predictors of Breast Conservation and Comparison of Long-Term Oncological Outcomes with Mastectomy
by Corrado Tinterri, Erika Barbieri, Andrea Sagona, Alberto Bottini, Giuseppe Canavese and Damiano Gentile
Cancers 2024, 16(6), 1169; https://doi.org/10.3390/cancers16061169 - 16 Mar 2024
Cited by 10 | Viewed by 1728
Abstract
Background: Neoadjuvant therapy (NAT) has become increasingly employed for the treatment of cT3-4 breast cancer (BC), enabling breast-conserving surgery (BCS) in cases traditionally considered for mastectomy. This study aims to identify predictors for breast conservation post-NAT and to evaluate whether BCS influences long-term [...] Read more.
Background: Neoadjuvant therapy (NAT) has become increasingly employed for the treatment of cT3-4 breast cancer (BC), enabling breast-conserving surgery (BCS) in cases traditionally considered for mastectomy. This study aims to identify predictors for breast conservation post-NAT and to evaluate whether BCS influences long-term oncological outcomes. Methods: We retrospectively analyzed data from patients with cT3-4 BC who received NAT at the Breast Unit of IRCCS Humanitas Research Hospital, Milan, Italy, from October 2009 to April 2020. Surgical outcomes and long-term oncological results, such as disease-free survival (DFS), distant DFS (DDFS), overall survival (OS), and BC-specific survival (BCSS), were compared between the BCS and mastectomy groups. Results: Among 114 patients analyzed, 37 (32.5%) underwent BCS, and 77 (67.5%) had a mastectomy. The key predictors for opting for BCS included absence of vascular invasion, reduced tumor size post-NAT, and achieving ypT0 status. No significant differences in DFS, DDFS, OS, and BCSS were observed between the two surgical groups (log-ranks, p = 0.520, p = 0.789, p = 0.216, p = 0.559, respectively). Conclusions: BCS after NAT is a feasible and safe option for patients with cT3-4 BC, without adversely affecting long-term oncological outcomes. Identifying predictors of breast conservation can guide surgical decision-making, ensuring that patients receive optimal treatment. Full article
(This article belongs to the Special Issue De-escalation of Axillary and Breast Cancer Surgery in the Setting of Neo-Adjuvant Chemotherapy)
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