Dr. Barrio on Neoadjuvant Chemo to De-Escalate Axillary Node Dissection in Breast Cancer

Andrea V. Barrio, MD, FACS
Published: Sunday, Oct 06, 2019



Andrea V. Barrio, MD, FACS, associate attending surgeon at Memorial Sloan Kettering Cancer Center, discusses how the use of neoadjuvant chemotherapy (NAC) can help de-escalate axillary node dissection in select patients with breast cancer. Dissection can be a morbid procedure with longterm risks of lymphoma, impacting the quality of life for many patients.

To use NAC to de-escalate surgical care in patients, Barrio says physicians must use the approach safely. Dissection can be de-escalated in those patients who have an excellent response to chemotherapy, such as those with HER2-positive or triple-negative disease. Those patients have had the best responses, and Barrio adds she has seen reductions in these patient populations.

However, Barrio warns that hormone receptor (HR)-positive and HER2-negative patients have less responses to the NAC. While surgical care may still be down-staged in a substantial amount of these patients, it is important to do so safely.

Overall, de-escalating the axillary node dissection can improve the quality of life for many patients with breast cancer, but Barrio concludes that any patients who still have residual disease following chemotherapy should not be considered for de-escalation.

<<< View more from the 2019 Lynn Sage Breast Cancer Symposium


Andrea V. Barrio, MD, FACS, associate attending surgeon at Memorial Sloan Kettering Cancer Center, discusses how the use of neoadjuvant chemotherapy (NAC) can help de-escalate axillary node dissection in select patients with breast cancer. Dissection can be a morbid procedure with longterm risks of lymphoma, impacting the quality of life for many patients.

To use NAC to de-escalate surgical care in patients, Barrio says physicians must use the approach safely. Dissection can be de-escalated in those patients who have an excellent response to chemotherapy, such as those with HER2-positive or triple-negative disease. Those patients have had the best responses, and Barrio adds she has seen reductions in these patient populations.

However, Barrio warns that hormone receptor (HR)-positive and HER2-negative patients have less responses to the NAC. While surgical care may still be down-staged in a substantial amount of these patients, it is important to do so safely.

Overall, de-escalating the axillary node dissection can improve the quality of life for many patients with breast cancer, but Barrio concludes that any patients who still have residual disease following chemotherapy should not be considered for de-escalation.

<<< View more from the 2019 Lynn Sage Breast Cancer Symposium

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