De-escalating local treatment for women with breast cancer

Document Type

Article

Publication Date

10-1-2022

Abstract

De-escalating therapy in breast cancer means doing less to achieve the same outcomes. Surgery to the breast de-escalated from the Halsted radical mastectomy to the modified radical mastectomy, and then to breast-conserving surgery (BCS), which is the current standard of care for early breast cancer. BCS includes a course of radiotherapy, which was de-escalated from a 6-week course to a 3-week course, with a boost to the tumour bed. As the majority of local recurrences occur in the quadrant where the primary tumour was located, a single intraoperative dose of radiotherapy to the cavity at the time of surgery in selected patients was equivalent to whole breast irradiation with a boost to the tumour bed. In tandem with de-escalating surgery to the breast, a full axillary dissection was de-escalated to sentinel lymph node biopsy (SLNB) in clinically node-negative patients. In patients with large tumours where breast conservation is not possible, neoadjuvant systemic therapy (NAST) can safely de-escalate a mastectomy to BCS. NAST can also downstage an axillary node-positive cancer to a node-negative one, so that SLNB can be performed. Lesser surgery will lead to less complications and thus a better quality of life. Current research is focused on treating breast cancer with systemic therapy alone, and selecting out a group of patients where breast or axillary surgery is not required. A major concern of de-escalating surgery is that some women may be undertreated and hence have poorer outcomes. A discussion on the pros and cons of de-escalating surgery is important when offering the choice to women.

Keywords

Breast cancer, De-escalation, Local treatment, Outcomes

Publication Title

Indian Journal Of Surgery

Divisions

surgerydept

Volume

84

Issue

SUPPL

Publisher

Springer India

Publisher Location

7TH FLOOR, VIJAYA BUILDING, 17, BARAKHAMBA ROAD, NEW DELHI, 110 001, INDIA

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