2024-SABCS-Takeaways - 9

Top Clinical Pearls in
SURGICAL ONCOLOGY
from 2024 SABCS®
» Active surveillance is not inferior to guidelineconcordant
care (surgery with or without RT) for
patients with low-risk DCIS at two years.
The next edition
of guidelines for
managing the axilla
from the American
Society of Clinical
Oncology (ASCO),
expected in 2025, will
include discussion
of this right-sizing
approach.
Neoadjuvant
chemotherapy can
have significant
effects on pathologic
complete response
(pCR) and on the
axilla. New data
suggest that patients
who show pCR and
no tumor cells or
micrometastases
on sentinel lymph
node biopsy (SLNB)
following neoadjuvant
chemotherapy do not
need axillary lymph
node dissection
(ALND). 
ON RIGHT-SIZING
BREAST CANCER TREATMENT
" Historically, breast cancer
therapy was all about adding
treatment. Targeted therapies
work just as well, if not better,
than chemotherapy for
all, opening the door to
doing less surgery. "
MONICA MORROW, MD,
Chief of Breast Surgical Service and the
Anne Burnett Windfohr Chair of
Clinical Oncology, Memorial
Sloan Kettering Cancer Center
» Omitting sentinel node surgery is not inferior
to sentinel node surgery for invasive disease-free
survival in cT1-2N0 patients following breastconserving
surgery and RT at five years.
» The most appropriate surgery for BRCA1
mutation carriers remains unclear. Conflicting
trials suggest greater benefit for bilateral
mastectomy or breast-conserving surgery, and
even better survival for RRSO.
» Diagnostic ALND should be discouraged
in patients with ypN0(i+) on SLND following
neoadjuvant chemotherapy and in patients
with ypN1(mi) who achieve pCR. ALND may
be appropriate only for patients with ypN1(mi)
without pCR, but only if adjuvant treatment is
likely to be modified by high nodal burden, such
as luminal tumor in BRCA carriers.
» Women with breast cancer who underwent
breast-conserving surgery or immediate breast
reconstruction have higher aesthetic breast
satisfaction as well as better psychosocial and
sexual well-being compared to mastectomy
patients. Women who had breast-conserving
surgery were significantly less adversely
affected by surgery.
Looking Ahead
» Four trials - LORIS, COMET, LORD, and
LORETTA - comparing active surveillance to
guideline concurrent care for DCIS are expected
to report in the next few years.
» More study is needed to reconcile conflicting
evidence on the relative survival advantages of
breast-conserving surgery, unilateral or
bilateral mastectomy, and RRSO for BRCA1
mutation carriers.
» Look for longer-term data on oncoplastic
breast-conserving surgery as an alternative to
mastectomy.
December 10-13, 2024 | San Antonio, Texas
9
2024-SABCS-Takeaways

Table of Contents for the Digital Edition of 2024-SABCS-Takeaways
