J Breast Cancer.  2017 Sep;20(3):228-233. 10.4048/jbc.2017.20.3.228.

Meeting Highlights: The Second Consensus Conference for Breast Cancer Treatment in Korea

Affiliations
  • 1Center for Breast Cancer, National Cancer Center, Goyang, Korea.
  • 2Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
  • 3Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 5Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. ikjae412@yuhs.ac
  • 6LeeHaeKyung Breast Thyroid Clinic, Seoul, Korea.
  • 7Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
  • 8Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 9Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 10Department of Surgery, Breast Care Center, Daerim St. Mary's Hospital, Seoul, Korea.
  • 11Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
  • 12Department of Oncology, University of Ulsan College of Medicine, Seoul, Korea.
  • 13Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

The Korean clinical practice guideline recently developed by the Korean Breast Cancer Society to address the national clinical situation is currently under revision ahead of a seventh recommendation. A second consensus conference was held to further develop this guideline by soliciting opinions regarding important issues related to surgery, radiotherapy, and medical oncology. Several issues were discussed, and the discussion progressed to pros and cons in the context of cases in various clinical situations. The panels discussed and voted on issues regarding surgical treatment for non-axillary regional lymph nodes, regional nodal irradiation of pN1 disease, and ovarian functional suppression (OFS) as an adjuvant treatment in premenopausal patients with hormone receptor-positive breast cancer. Regarding the surgical treatment of non-axillary regional lymph node, most panelists agreed with the recommendation of preoperative chemotherapy and postoperative radiotherapy for patients with biopsy-diagnosed metastases, whereas surgery or radiotherapy of non-axillary regional lymph nodes was suggested for clinical partial responders. Discussions on radiotherapy addressed the need for adjuvant radiotherapy and radiation field of regional lymph node in the context of various N1 breast cancer cases. The participants reached a consensus to recommend that N1 patients should receive regional nodal irradiation for a large tumor burden (e.g., three positive nodes, perinodal extension, or large primary tumor). Finally, the panels favored OFS in addition to endocrine therapy for premenopausal women with high risk factors such as a large tumor size, involvement of more than three nodes, and a high histologic grade.

Keyword

Breast neoplasms; Consensus; Interdisciplinary communication

MeSH Terms

Breast Neoplasms*
Consensus*
Drug Therapy
Female
Humans
Interdisciplinary Communication
Korea*
Lymph Nodes
Medical Oncology
Neoplasm Metastasis
Radiotherapy
Radiotherapy, Adjuvant
Risk Factors
Tumor Burden

Reference

1. Oh CM, Won YJ, Jung KW, Kong HJ, Cho H, Lee JK, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2013. Cancer Res Treat. 2016; 48:436–450.
Article
2. Min SY, Kim Z, Hur MH, Yoon CS, Park EH, Jung KW, et al. The basic facts of Korean breast cancer in 2013: results of a nationwide survey and breast cancer registry database. J Breast Cancer. 2016; 19:1–7.
Article
3. Francis PA, Regan MM, Fleming GF, Láng I, Ciruelos E, Bellet M, et al. Adjuvant ovarian suppression in premenopausal breast cancer. N Engl J Med. 2015; 372:436–446.
Article
4. Pagani O, Regan MM, Walley BA, Fleming GF, Colleoni M, Láng I, et al. Adjuvant exemestane with ovarian suppression in premenopausal breast cancer. N Engl J Med. 2014; 371:107–118.
Article
5. Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015; 373:307–316.
Article
6. Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015; 373:317–327.
Article
7. Park SH, Kim JC, Lee JE, Park IK. Virtual lymph node analysis to evaluate axillary lymph node coverage provided by tangential breast irradiation. Radiat Oncol J. 2015; 33:50–56.
Article
8. Hennequin C, Bossard N, Servagi-Vernat S, Maingon P, Dubois JB, Datchary J, et al. Ten-year survival results of a randomized trial of irradiation of internal mammary nodes after mastectomy. Int J Radiat Oncol Biol Phys. 2013; 86:860–866.
Article
9. Nielsen HM, Overgaard M, Grau C, Jensen AR, Overgaard J. Loco-regional recurrence after mastectomy in high-risk breast cancer: risk and prognosis: an analysis of patients from the DBCG 82 b&c randomization trials. Radiother Oncol. 2006; 79:147–155.
Article
10. Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson KS, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst. 2005; 97:116–126.
Article
11. EBCTCG (Early Breast Cancer Trialists' Collaborative Group). McGale P, Taylor C, Correa C, Cutter D, Duane F, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014; 383:2127–2135.
Article
12. Tendulkar RD, Rehman S, Shukla ME, Reddy CA, Moore H, Budd GT, et al. Impact of postmastectomy radiation on locoregional recurrence in breast cancer patients with 1-3 positive lymph nodes treated with modern systemic therapy. Int J Radiat Oncol Biol Phys. 2012; 83:e577–e581.
Article
13. Kim SI, Cho SH, Lee JS, Moon HG, Noh WC, Youn HJ, et al. Clinical relevance of lymph node ratio in breast cancer patients with one to three positive lymph nodes. Br J Cancer. 2013; 109:1165–1171.
Article
14. Chang JS, Lee J, Kim KH, Sohn JH, Kim SI, Park BW, et al. Do recent advances in diagnostic and therapeutic procedures negate the benefit of postmastectomy radiotherapy in N1 patients with a low risk of locoregional recurrence? Medicine (Baltimore). 2015; 94:e1259.
Article
15. Chang JS, Choi JE, Park MH, Jung SH, Choi BO, Park HS, et al. Trends in the application of postmastectomy radiotherapy for breast cancer with 1 to 3 positive axillary nodes and tumors ≤5 cm in the modern treatment era: a retrospective Korean Breast Cancer Society report. Medicine (Baltimore). 2016; 95:e3592.
16. Park HJ, Shin KH, Kim JH, Ahn SD, Kim JY, Park W, et al. Incorporating risk factors to identify the indication of post-mastectomy radiotherapy in N1 breast cancer treated with optimal systemic therapy: a multicenter analysis in Korea (KROG 14-23). Cancer Res Treat. 2017; 49:739–747.
Article
17. Kunkler IH, Canney P, van Tienhoven G, Russell NS. MRC/EORTC (BIG 2-04) SUPREMO Trial Management Group. Elucidating the role of chest wall irradiation in ‘intermediate-risk’ breast cancer: the MRC/EORTC SUPREMO trial. Clin Oncol R Coll Radiol. 2008; 20:31–34.
Article
18. Han A, Lee KE, Lee HK, Park YH, Kim J, Kim SW, et al. Meeting highlights: the first Korean breast cancer treatment consensus conference. J Breast Cancer. 2014; 17:308–313.
Article
19. Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014; 15:1303–1310.
Article
20. Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011; 305:569–575.
Article
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